Provider Demographics
NPI:1629157789
Name:BRYAN MEDICAL CENTER
Entity Type:Organization
Organization Name:BRYAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-481-3548
Mailing Address - Street 1:P.O. BOX 6168
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-0168
Mailing Address - Country:US
Mailing Address - Phone:402-483-8590
Mailing Address - Fax:402-483-8599
Practice Address - Street 1:1600 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1283
Practice Address - Country:US
Practice Address - Phone:402-489-0200
Practice Address - Fax:402-481-4755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-02
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2132Medicare PIN
099891Medicare PIN