Basic Information
Provider Information | |||||||||
NPI: | 1427152131 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COLUMBUS COMMUNITY HOSPITAL INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CCH PROFESSIONAL SERVICES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1800 | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | NE | ||||||||
PostalCode: | 686021800 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4025647118 | ||||||||
FaxNumber: | 4025623378 | ||||||||
Practice Location | |||||||||
Address1: | 4600 38TH ST | ||||||||
Address2: |   | ||||||||
City: | COLUMBUS | ||||||||
State: | NE | ||||||||
PostalCode: | 686011664 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4025647118 | ||||||||
FaxNumber: | 4025623378 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/12/2006 | ||||||||
LastUpdateDate: | 07/24/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | VAN CLEAVE | ||||||||
AuthorizedOfficialFirstName: | CHAD | ||||||||
AuthorizedOfficialMiddleName: | E | ||||||||
AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT FINANCE | ||||||||
AuthorizedOfficialTelephone: | 4025647118 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | COLUMBUS COMMUNITY HOSPITAL INC | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/24/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | 363A00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363L00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 367500000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   | 133V00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |   | 207P00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 81052 | 01 | NE | BCBS NE (CDE) GRP # | OTHER | 03417 | 01 | NE | BCBS NE (LOCUMS) GRP # | OTHER | 119099 | 01 | NE | COVENTRY (CRNA) GROUP # | OTHER | 84476 | 01 | NE | COVENTRY (ER) GROUP # | OTHER | 08554 | 01 | NE | BCBS NE (CRNA) GRP # | OTHER | H123 | 01 | NE | MIDLANDS CHOICE GRP # | OTHER |