Provider Demographics
NPI:1922462902
Name:JEFFERSON COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CENTER INC
Other - Org Name:JEFFERSON COMMUNITY HEALTH & LIFE FAIRBURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BURKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-729-3351
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-0277
Mailing Address - Country:US
Mailing Address - Phone:402-729-3351
Mailing Address - Fax:402-729-6026
Practice Address - Street 1:2200 H ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-1119
Practice Address - Country:US
Practice Address - Phone:402-729-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-06
Last Update Date:2022-11-22
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