NPIMap

Organization Active NPI

Jennie M Melham Memorial Medical Center

  • Nursing Facility/Intermediate Care Facility
  • Broken Bow, NE
National Provider Identifier
1093880072
Registry record updated Jan 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
LTCH004 Issued in NE
Legal business name
JENNIE M MELHAM MEMORIAL MEDICAL CENTER
Practice address
145 Memorial Dr
Broken Bow, NE 68822-1378
Phone
(308) 872-2625
Fax
(308) 872-6116
NPI assigned
Nov 22, 2006
Last updated
Jan 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2020

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

Authorized official

Name
Mr. Timothy L Schuckman
Title
Vice President-Cfo
Phone
(307) 872-2625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X LTCH004 NE Primary

Addresses

Primary practice location

145 Memorial Dr
Broken Bow, NE 68822-1378

Mailing address

PO Box 250
Broken Bow, NE 68822-0250
Phone (308) 872-2625

Other names 1

  • Jennie M. Melham Memorial Medical Center-LTC Other name

National Provider Directory

National Provider Directory
Tax ID family
Jennie M Melham Mem Med Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578614400000",
    "number": "1093880072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688220250",
            "telephone_number": "308-872-2625",
            "fax_number": "308-872-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MEMORIAL DR",
            "city": "BROKEN BOW",
            "state": "NE",
            "postal_code": "688221378",
            "telephone_number": "308-872-2625",
            "fax_number": "308-872-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIE M MELHAM MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A",
        "authorized_official_last_name": "SCHUCKMAN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT-CFO",
        "authorized_official_telephone_number": "307-872-2625",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "NE",
            "license": "LTCH004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jennie M. Melham Memorial Medical Center-LTC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Jennie M. Melham Memorial Medical Center-LTC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Broken Bow, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.