Provider Demographics
NPI:1922051531
Name:GOTHENBURG MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GOTHENBURG MEMORIAL HOSPITAL
Other - Org Name:GOTHENBURG HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-537-3661
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-0469
Mailing Address - Country:US
Mailing Address - Phone:308-537-3661
Mailing Address - Fax:308-537-3074
Practice Address - Street 1:910 20TH ST
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-1253
Practice Address - Country:US
Practice Address - Phone:308-537-3661
Practice Address - Fax:308-537-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE281313Medicare Oscar/Certification