Provider Demographics
NPI:1891738936
Name:AVERA ST ANTHONYS HOSPITAL
Entity Type:Organization
Organization Name:AVERA ST ANTHONYS HOSPITAL
Other - Org Name:AVERA ST. ANTHONY'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONSBRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-2611
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0270
Mailing Address - Country:US
Mailing Address - Phone:402-336-5154
Mailing Address - Fax:402-336-5137
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:
Practice Address - City:O'NEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1514
Practice Address - Country:US
Practice Address - Phone:402-336-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE410002282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH00118OtherBC-NE HOSP PROV #
NEH136OtherMIDLANDS CHOICE PROVIDER
NE=========OtherCOMMERCIAL PAYORS
NE=========00Medicaid
NE=========OtherCOMMERCIAL PAYORS