Provider Demographics
NPI:1689891087
Name:MORRILL COUNTY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:MORRILL COUNTY COMMUNITY HOSPITAL
Other - Org Name:CHIMNEY ROCK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-262-1616
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-0682
Mailing Address - Country:US
Mailing Address - Phone:308-586-1717
Mailing Address - Fax:308-586-1263
Practice Address - Street 1:320 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NE
Practice Address - Zip Code:69334-1500
Practice Address - Country:US
Practice Address - Phone:308-586-1717
Practice Address - Fax:308-586-1263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORRILL COUNTY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2014-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03135OtherBCBS OF NEBRASKA
NE=========12Medicaid
NE=========12Medicaid
NE098005Medicare PIN