Provider Demographics
| NPI: | 1356656417 |
|---|---|
| Name: | THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION |
| Entity type: | Organization |
| Organization Name: | THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | ERIC |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | BARBER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 402-461-5108 |
| Mailing Address - Street 1: | 715 NORTH ST. JOSEPH AVENUE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HASTINGS |
| Mailing Address - State: | NE |
| Mailing Address - Zip Code: | 68901-4497 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 402-463-4521 |
| Mailing Address - Fax: | 402-461-5321 |
| Practice Address - Street 1: | 715 N SAINT JOSEPH AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | HASTINGS |
| Practice Address - State: | NE |
| Practice Address - Zip Code: | 68901-4497 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 402-463-4521 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2010-08-13 |
| Last Update Date: | 2022-10-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
| No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NE | NA1676 | Medicare PIN |