Provider Demographics
NPI:1750394409
Name:AVERA ST ANTHONYS HOSPITAL
Entity type:Organization
Organization Name:AVERA ST ANTHONYS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONSBRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-2611
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0270
Mailing Address - Country:US
Mailing Address - Phone:402-336-5154
Mailing Address - Fax:402-336-5137
Practice Address - Street 1:300 NORTH 2ND ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1514
Practice Address - Country:US
Practice Address - Phone:402-336-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA ST ANTHONYS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-14
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEESRD028261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH0118OtherBC HOSPITAL #
NE=========OtherCOMMERCIAL PROV #
NE=========10Medicaid
NE=========10Medicaid