Basic Information
| Provider Information | |||||||||
| NPI: | 1033632732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FILLMORE COUNTY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 F ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 683612229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027593192 | ||||||||
| FaxNumber: | 4027593186 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 F STREET | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4027593192 | ||||||||
| FaxNumber: | 4027593186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PAWLWOSKI | ||||||||
| AuthorizedOfficialFirstName: | KRISTI | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4027593192 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PLMHP, LADC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NE | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1457745119 | 05 | NE | MEDICAID |