Provider Demographics
NPI:1851348544
Name:COMMUNITY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CENTER, INC
Other - Org Name:HUMBOLDT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-245-2428
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-0399
Mailing Address - Country:US
Mailing Address - Phone:402-245-4475
Mailing Address - Fax:402-245-6651
Practice Address - Street 1:1120 GRAND AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:NE
Practice Address - Zip Code:68376-6019
Practice Address - Country:US
Practice Address - Phone:402-862-3280
Practice Address - Fax:402-862-3284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE283493Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE