Basic Information
Provider Information | |||||||||
NPI: | 1003858846 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SAINT FRANCIS MEDICAL CENTER | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 9804 | ||||||||
Address2: |   | ||||||||
City: | GRAND ISLAND | ||||||||
State: | NE | ||||||||
PostalCode: | 688029804 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3083984600 | ||||||||
FaxNumber: | 3083985574 | ||||||||
Practice Location | |||||||||
Address1: | 2620 W FAIDLEY AVE | ||||||||
Address2: |   | ||||||||
City: | GRAND ISLAND | ||||||||
State: | NE | ||||||||
PostalCode: | 688034205 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3083844600 | ||||||||
FaxNumber: | 3083985574 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2006 | ||||||||
LastUpdateDate: | 02/10/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KUIPER | ||||||||
AuthorizedOfficialFirstName: | EVERT | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO - CHI HEALTH | ||||||||
AuthorizedOfficialTelephone: | 4023434420 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/10/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 370001 | NE | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | D03446 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER |