Provider Demographics
NPI:1134216773
Name:BRYAN MEDICAL CENTER
Entity type:Organization
Organization Name:BRYAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-481-1111
Mailing Address - Street 1:1600 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1299
Mailing Address - Country:US
Mailing Address - Phone:402-481-5792
Mailing Address - Fax:402-481-4755
Practice Address - Street 1:2300 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3780
Practice Address - Country:US
Practice Address - Phone:402-475-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
283Q00000X
NE500003273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE611OtherBC/BS PROVIDER NUMBER
NE611OtherBC/BS PROVIDER NUMBER