Provider Demographics
NPI:1790792729
Name:PERKINS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PERKINS COUNTY HOSPITAL DISTRICT
Other - Org Name:GRANT MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBRUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-352-7200
Mailing Address - Street 1:912 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3099
Mailing Address - Country:US
Mailing Address - Phone:308-352-7100
Mailing Address - Fax:308-352-7103
Practice Address - Street 1:912 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3099
Practice Address - Country:US
Practice Address - Phone:308-352-7100
Practice Address - Fax:308-352-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4142261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========18Medicaid
283989Medicare Oscar/Certification