Basic Information
| Provider Information | |||||||||
| NPI: | 1902893456 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLUMBUS COMMUNITY HOSPITAL INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HOME HEALTH OF 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: | 3005 19TH ST | ||||||||
| Address2: | STE 600 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686014248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025623300 | ||||||||
| FaxNumber: | 4025624613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 05/15/2015 | ||||||||
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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: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 631001 | NE | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 00377 | 01 | NE | BCBS NE HOME HEALTH | OTHER | F318 | 01 | NE | MIDLANDS CHOICE HHA | OTHER |