Basic Information
| Provider Information | |||||||||
| NPI: | 1871652453 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOX BUTTE GENERAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GREATER NEBRASKA MEDICAL & SURGICAL SERVICES - ALLIANCE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 810 | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693010810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087626660 | ||||||||
| FaxNumber: | 3087621923 | ||||||||
| Practice Location | |||||||||
| Address1: | 2091 BOX BUTTE AVE | ||||||||
| Address2: | |||||||||
| City: | ALLIANCE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693014452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3087627244 | ||||||||
| FaxNumber: | 3087626657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 11/11/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GRIESS | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3087626660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BOX BUTTE GENERAL HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 10025695200 | 05 | NE | MEDICAID | 10025028100 | 05 | NE | MEDICAID | 10025695300 | 05 | NE | MEDICAID | 10025695400 | 05 | NE | MEDICAID |