BRODSTONE MEMORIAL HOSPITAL NPI 1073590626

NPI Information

NPI: 1073590626
Provider Name: BRODSTONE MEMORIAL HOSPITAL

Doing Business As: SUPERIOR FAMILY MEDICAL CENTER

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
525 E 11TH ST
SUPERIOR, NE
ZIP 68978
Phone: (402) 879-4781
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BRODSTONE MEMORIAL HOSPITAL is a rural health clinic center in Superior, NE. BRODSTONE MEMORIAL HOSPITAL NPI is 1073590626. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Superior Family Medical Center.

The provider's business location address is:

525 E 11TH ST
SUPERIOR, NE
ZIP 68978-101
Phone: (402) 879-4781
Fax: (402) 879-3365

The provider's authorized official is Treg Vyzourek .
The authorized official title is Ceo and has the following contact phone number (402) 879-3281.

The CLIA number assigned to this NPI record is 28D1027384 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/26/2005 and was last updated on 3/23/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207Q00000X	Family Medicine		No
2	363A00000X	Physician Assistant		No
3	363L00000X	Nurse Practitioner		No
4	261QR1300X	Clinic/Center	Rural Health	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	10025177900	MEDICAID	NEBRASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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