Provider Demographics
NPI:1982779641
Name:JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-872-4100
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:NE
Mailing Address - Zip Code:68822-0250
Mailing Address - Country:US
Mailing Address - Phone:308-872-4100
Mailing Address - Fax:308-872-4175
Practice Address - Street 1:145 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:NE
Practice Address - Zip Code:68822-1378
Practice Address - Country:US
Practice Address - Phone:308-872-4100
Practice Address - Fax:308-872-4175
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100004275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
0559OtherBLUE CROSS SWB NUMBER
0559OtherBLUE CROSS SWB NUMBER