Provider Demographics
NPI:1245281138
Name:CRETE AREA MEDICAL CENTER
Entity type:Organization
Organization Name:CRETE AREA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-826-2102
Mailing Address - Street 1:PO BOX 860873
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0873
Mailing Address - Country:US
Mailing Address - Phone:402-826-2102
Mailing Address - Fax:402-826-7950
Practice Address - Street 1:2910 BETTEN DR
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-3084
Practice Address - Country:US
Practice Address - Phone:402-826-2102
Practice Address - Fax:402-826-7950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRETE AREA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35536OtherBCBS OF NEBRASKA
NE08802OtherBCBS OF NEBRASKA
NE81078OtherBCBS OF NEBRASKA
NECJ5613OtherRAILROAD MEDICARE
NE38175OtherBCBS OF NEBRASKA
NECJ5613OtherRAILROAD MEDICARE
NE=========12Medicaid
NE35536OtherBCBS OF NEBRASKA
NE81078OtherBCBS OF NEBRASKA
NE08802OtherBCBS OF NEBRASKA
NE35536OtherBCBS OF NEBRASKA