Basic Information
| Provider Information | |||||||||
| NPI: | 1598869240 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBUS COMMUNITY HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLUMBUS COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| 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: | 05/15/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| 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: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | LTCH007 | NE | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 275N00000X | 630001 | NE | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 00162 | 01 | NE | BCBS NE SNF | OTHER |