Provider Demographics
NPI:1851737316
Name:ST. MARY'S COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:ST. MARY'S COMMUNITY HOSPITAL
Other - Org Name:NEBRASKA CITY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO - CHI HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:EVERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-343-4420
Mailing Address - Street 1:1301 GRUNDMAN BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-3320
Mailing Address - Country:US
Mailing Address - Phone:402-873-4242
Mailing Address - Fax:
Practice Address - Street 1:1301 GRUNDMAN BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-3320
Practice Address - Country:US
Practice Address - Phone:402-873-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE288522Medicare Oscar/Certification