NPIMap

Organization Active NPI

Memorial Community Health Inc

Doing business as Memorial Health Clinic Aurora (RHC)

  • Rural Health Clinic/Center
  • Aurora, NE
National Provider Identifier
1083326193
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEMORIAL COMMUNITY HEALTH INC
Doing business as
Memorial Health Clinic Aurora (RHC)
Practice address
609 O St
Aurora, NE 68818-1104
Phone
(402) 694-3191
Fax
(402) 694-2146
NPI assigned
Dec 20, 2022
Last updated
Dec 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL COMMUNITY HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Phil J Fendt
Title
Cfo
Phone
(402) 694-3171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

609 O St
Aurora, NE 68818-1104

Mailing address

609 O St
Aurora, NE 68818-1104
Phone (402) 694-3191

Other names 1

  • MEMORIAL HEALTH CLINIC AURORA (RHC) Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230227002018 NE Part A Provider - Rural Health Clinic 1355394040 Practice locations: Aurora, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083326193. Details of each certification follow.

Rural health clinic certification: CCN 288558

Legal name
MEMORIAL COMMUNITY HEALTH INC
Doing business as
MEMORIAL HEALTH CLINIC AURORA (RHC)
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 28, 2023
Last certification
Aug 28, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 26, 1960 in NE
Enrollment address
609 O St
Aurora, NE 68818-1100
Related CCNs
281320

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Memorial Community Care6 organizations share this tax ID, including this one
Part of
Memorial Community Care

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

319 W Glenvil St
Clay Center, NE 68933
Phone (402) 762-3236

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bradley Bish Individual Corporate DirectorDirector Jul 1, 2010
Cody Hoegh Individual Corporate DirectorDirector May 1, 2020
Chad Garrett Individual Corporate DirectorDirector Mar 1, 2020
Wayne Hahn Individual Corporate DirectorDirector Sep 1, 2014
Kenneth Spray Individual Corporate DirectorDirector Apr 1, 2018
Jayne Smith Individual Corporate DirectorTreasurer Oct 26, 2004
Harlan Schafer Individual Corporate DirectorDirector May 1, 2018
Clinton Mickey Individual Corporate DirectorDirector Apr 1, 2019
Justin Wolf Individual Corporate OfficerCeo Jun 27, 2022
W-2 Managing EmployeeCeo Jun 27, 2022
Dennis Ferguson Individual Corporate DirectorPresident Apr 1, 2004
Jennie Akerlund-Kuehner Individual Corporate DirectorSecretary Sep 1, 2012
Roger Scott Individual Corporate DirectorDirector May 1, 2009
Pamela Riley Individual Corporate DirectorDirector Apr 1, 2019
Jason Schneider Individual Corporate DirectorVice President Nov 1, 1996
Mark Klute Individual Corporate DirectorDirector Apr 1, 2014
Brandi Nigro Individual W-2 Managing EmployeeClinic Manager Jan 3, 2022
Phil Fendt Individual Corporate OfficerCfo Jul 15, 1992
W-2 Managing EmployeeCfo Jul 15, 1992

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1083326193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 O ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181104",
            "telephone_number": "402-694-3191",
            "fax_number": "402-694-2146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 O ST",
            "city": "AURORA",
            "state": "NE",
            "postal_code": "688181104",
            "telephone_number": "402-694-3191",
            "fax_number": "402-694-2146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL COMMUNITY HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL COMMUNITY HEALTH INC",
        "enumeration_date": "2022-12-20",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "FENDT",
        "authorized_official_first_name": "PHIL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "402-694-3171"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL HEALTH CLINIC AURORA (RHC)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aurora, NE

Sources for this page

Verify at the official NPI Registry.