Provider Demographics
NPI:1629344692
Name:AVERA ST ANTHONYS HOSPITAL
Entity Type:Organization
Organization Name:AVERA ST ANTHONYS HOSPITAL
Other - Org Name:AVERA MEDICAL GROUP SPENCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-2611
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0270
Mailing Address - Country:US
Mailing Address - Phone:402-336-2900
Mailing Address - Fax:
Practice Address - Street 1:103 S THAYER ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NE
Practice Address - Zip Code:68777-9784
Practice Address - Country:US
Practice Address - Phone:402-589-1328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA ST ANTHONYS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-23
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health