Provider Demographics
NPI:1780895110
Name:JOHNSON COUNTY HOSPITAL
Entity type:Organization
Organization Name:JOHNSON COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-335-3361
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:NE
Mailing Address - Zip Code:68450-0538
Mailing Address - Country:US
Mailing Address - Phone:402-335-2811
Mailing Address - Fax:402-335-2826
Practice Address - Street 1:202 HIGH STREET
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:NE
Practice Address - Zip Code:68450
Practice Address - Country:US
Practice Address - Phone:402-335-3361
Practice Address - Fax:402-335-6342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNSON COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-25
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025541800Medicaid
NE10025542100Medicaid
NE096938Medicare PIN