Basic Information
Provider Information
NPI: 1891423943
EntityType: 2
ReplacementNPI:  
OrganizationName: COLUMBUS COMMUNITY HOSPITAL INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: LINDSAY MEDICAL CLINIC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1800
Address2:  
City: COLUMBUS
State: NE
PostalCode: 686021800
CountryCode: US
TelephoneNumber: 4025647118
FaxNumber: 4025623378
Practice Location
Address1: 110 PINE ST
Address2:  
City: LINDSAY
State: NE
PostalCode: 686444623
CountryCode: US
TelephoneNumber: 4025647118
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/08/2022
LastUpdateDate: 09/29/2022
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:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 
363A00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363L00000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

No ID Information.


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