Provider Demographics
NPI:1689203077
Name:BRYAN MEDICAL CENTER
Entity Type:Organization
Organization Name:BRYAN MEDICAL CENTER
Other - Org Name:BRYAN MEDICAL CENTER LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
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 1:1600 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1299
Mailing Address - Country:US
Mailing Address - Phone:402-481-3548
Mailing Address - Fax:402-481-8306
Practice Address - Street 1:2221 S 17TH ST
Practice Address - Street 2:STE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3763
Practice Address - Country:US
Practice Address - Phone:402-481-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-07
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory