Provider Demographics
NPI:1871511063
Name:VALLEY COUNTY HOSPITAL
Entity Type:Organization
Organization Name:VALLEY COUNTY HOSPITAL
Other - Org Name:VALLEY COUNTY DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:308-728-4293
Mailing Address - Street 1:2707 L STREET
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1275
Mailing Address - Country:US
Mailing Address - Phone:308-728-4200
Mailing Address - Fax:308-728-7809
Practice Address - Street 1:400 S 23RD ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1619
Practice Address - Country:US
Practice Address - Phone:308-728-4281
Practice Address - Fax:308-728-7614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========54Medicaid
NE=========54Medicaid