Provider Demographics
NPI:1497952725
Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEET
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-461-5108
Mailing Address - Street 1:715 N KANSAS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4453
Mailing Address - Country:US
Mailing Address - Phone:402-460-5787
Mailing Address - Fax:
Practice Address - Street 1:908 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3556
Practice Address - Country:US
Practice Address - Phone:308-384-4085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025483300Medicaid
NE10025483300Medicaid
NEPENDINGMedicare ID - Type UnspecifiedPROVIDER #