BRODSTONE MEMORIAL HOSPITAL (NPI# 1073590626) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073590626 |
| Entity Type | Organization |
| Organization Name | BRODSTONE MEMORIAL HOSPITAL |
| Other Organization Name | SUPERIOR FAMILY MEDICAL CENTER |
| Practice Address |
525 E 11th St Superior NE 68978-1101 |
| Mailing Address |
Po Box 407 Superior NE 68978-0407 |
| Practice Telephone | 4028794781 |
| Practice Fax Number | 4028793365 |
| Mailing Telephone | 4028794781 |
| Mailing Fax Number | 4028793365 |
| Enumeration Date | 2005-12-26 |
| Last Update Date | 2018-01-11 |
| Authorized Official Name | SANDRA BORDEN (CFO) |
| Authorized Official Telephone | 4028793281 |
| Is Organization Subpart | Y |
| Parent Organization Name | BRODSTONE MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10025177900 | 05 |
| Other Name | Type Code |
|---|---|
| Superior Family Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477637619 | Brodstone Memorial Hospital | Home Health | 1050 Washington St, Superior, NE 68978-1149 | 2006-10-24 |
| 1114999547 | Brodstone Memorial Hospital | Family Medicine | 76 W 8th St, Nelson, NE 68961-6130 | 2006-02-01 |
| 1699746248 | Brodstone Memorial Hospital | Family Medicine | 315 N C St, Edgar, NE 68935-3194 | 2006-01-31 |
| 1306842604 | Brodstone Memorial Hospital | General Acute Care Hospital | 520 E 10th St, Superior, NE 68978-1225 | 2005-06-22 |
| 1699855023 | Brodstone Memorial Hospital | Medicare Defined Swing Bed Unit | 520 E 10th St, Superior, NE 68978-1225 | 2006-10-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BRODSTONE MEMORIAL HOSPITAL | 520 E 10th St, Superior, NE 68978-1225 |
| Street Address |
525 E 11TH ST |
| City | SUPERIOR |
| State | NE |
| Zip Code | 68978-1101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790777936 | Timothy Blecha | Specialist | 525 E 11th St, Superior, NE 68978-1101 | 2005-08-15 |
| 1568756609 | Alisha Fangmeyer | Nurse Practitioner | 525 E 11th St, Superior, NE 68978-1101 | 2011-06-07 |
| 1245552140 | Matthew Gatlin | Physician Assistant | 525 E 11th St, Superior, NE 68978-1101 | 2010-02-18 |
| 1578540126 | Robert G Leibel | Family Medicine | 525 E 11th St, Superior, NE 68978-1101 | 2005-12-26 |
| 1295712842 | Julie A Theis | Family Medicine | 525 E 11th St, Superior, NE 68978-1101 | 2005-12-26 |
| 1831176486 | Jason G Hass | Physician Assistant | 525 E 11th St, Superior, NE 68978-1101 | 2005-12-26 |
| 1477530020 | Teresa B Frahm | Nurse Practitioner | 525 E 11th St, Superior, NE 68978-1101 | 2005-12-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144475740 | Superior Vision PC | Eyewear Supplier (Equipment, not the service) | 358 Central Ave, Superior, NE 68978 | 2008-11-24 |
| 1427234160 | Elinor Lynn Wilton | Speech-Language Pathologist | 4034 Road C, Superior, NE 68978 | 2008-01-11 |
| 1780720904 | Sharon Greenwood | Counselor | 344 North Dakota, Superior, NE 68978 | 2007-01-29 |
| 1780776583 | South Central Behavioral Services | Clinic/Center | 520 East 10th Street, Broadstone Memorial Hospital, Superior, NE 68978 | 2006-09-29 |
| 1780804112 | Terry Dale Kermoade | Pharmacist | 520 East 10th Street, Superior, NE 68978 | 2007-04-26 |
| 1033288097 | Peggy Ann Meyer | Counselor | 520 E 10th St, Superior, NE 68978 | 2006-11-06 |
| 1013024215 | Steve Abe Fox | Nurse Anesthetist, Certified Registered | 1324 Montana St, Superior, NE 68978-1038 | 2006-08-24 |
| 1154702611 | Kingswood Court Assisted Living, LLC | Assisted Living Facility | 1005 Idaho St, Superior, NE 68978-1103 | 2015-06-10 |
| 1477637619 | Brodstone Memorial Hospital | Home Health | 1050 Washington St, Superior, NE 68978-1149 | 2006-10-24 |
| 1144496589 | Positive Solutions, Inc | Social Worker | 1050 Washington St, Superior, NE 68978-1149 | 2008-05-06 |
| Find all providers in zip 68978 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1356676761 | Oakland Mercy Hospital | Clinic/Center | 600 E Fulton St, Hooper, NE 68031-3074 | 2009-10-03 |
| 1659528412 | Regional West Physicians Clinic | Clinic/Center | 302 Center Ave, Morrill, NE 69358-3017 | 2008-08-25 |
| 1073776886 | Minden Family Practice Clinic Inc | Clinic/Center | 345 N Minden Ave, Minden, NE 68959-1657 | 2008-07-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.