Provider Demographics
NPI:1891189809
Name:PHELPS MEMORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:PHELPS MEMORIAL HEALTH CENTER
Other - Org Name:PHELPS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-995-2211
Mailing Address - Street 1:1215 TIBBALS ST
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1255
Mailing Address - Country:US
Mailing Address - Phone:308-995-2211
Mailing Address - Fax:308-995-3223
Practice Address - Street 1:1315 TIBBALS ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1257
Practice Address - Country:US
Practice Address - Phone:308-995-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHELPS MEMORIAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-27
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily 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
NENA2709Medicare PIN
NE288543Medicare Oscar/Certification