Provider Demographics
NPI:1811913767
Name:WEST HOLT MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WEST HOLT MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-925-1947
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NE
Mailing Address - Zip Code:68713-0277
Mailing Address - Country:US
Mailing Address - Phone:402-925-2651
Mailing Address - Fax:402-925-2652
Practice Address - Street 1:313 W PEARL ST
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NE
Practice Address - Zip Code:68713-4958
Practice Address - Country:US
Practice Address - Phone:402-925-2651
Practice Address - Fax:402-925-2652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST HOLT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6873336C0003X
NE26853336C0003X
NE13162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025343800Medicaid
2053169OtherPK
2053169OtherPK