Antelope Memorial Hospital
Organization Active NPI Rural Health Clinic/Center · Elgin, NE
NPI 1184705477 · NPPES record last updated Nov 18, 2022
Key facts
- NPI
- 1184705477
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ANTELOPE MEMORIAL HOSPITAL
- Practice address
- 101 West Cedar St
Elgin, NE 68636-4490 - Phone
- (402) 843-5444
- NPI assigned
- Oct 17, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- ANTELOPE MEMORIAL HOSPITAL
Authorized official
- Name
- Diane M Brugger
- Title
- Administrator
- Phone
- (402) 887-4151
Owners & managing parties with NPI records 1
-
Troy Olan Dawson, M.D.
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 9
Related certifications (CCN) 1
Practitioners 18
-
Meggie M Anderson, APRN
-
Thomas M Beutler, MD
-
Steven H Carlsen, PA-C
-
Troy Olan Dawson, M.D.
-
Anita R Murphy, PA-C
-
Ashley M Niewohner, APRN
-
Kelli Rae Osborn, M.D.
-
Roger Paul Rudloff, M.D.
-
Chelsea Marie Smith, APRN-NP
-
Angela M Sucha, PA-C
-
Joshua Reynold Thoendel, M.D.
-
Prakrity Urja, MD
-
Douglas Welsh, M.D.
-
Kimberly A Wiese, APRN
-
Jamie Lund Olsen, D.O.
-
David T. Schachter, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 28D0935049 | Amh - Elgin Clinic | Certificate of waiver | Mar 31, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Rural health clinic certification: CCN 283472
- Legal name
- ANTELOPE MEMORIAL HOSPITAL
- Doing business as
- AMH ELGIN CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 1, 2004
- Last certification
- May 10, 2023
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 3, 1952 in NE
- Enrollment address
- 101 W Cedar St
Elgin, NE 68636-4490 - Related CCNs
- 281326
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Troy Olan Dawson |
W-2 Managing Employee |
Jul 1, 2004 | |
| Operational/Managerial Control |
Jul 1, 2004 | ||
| Maury M Soper |
Corporate Director | Mar 24, 2021 | |
| Gordon W Shrader |
Corporate Director | May 1, 2009 | |
| David P Sullivan |
Corporate Director | Jun 1, 1999 | |
| Tanya Sharp |
W-2 Managing Employee |
Oct 9, 2023 | |
| Operational/Managerial Control |
Oct 9, 2023 | ||
| Jon Schilling |
Corporate Director | Nov 24, 2015 | |
| Samantha Stoltz |
Corporate Officer | Jun 25, 2025 | |
| Corporate Director | Jul 28, 2015 | ||
| John J Mlnarik |
Corporate Officer | Nov 1, 2009 | |
| Corporate Director | Feb 1, 1985 | ||
| Russell M Vetick |
Corporate Director | Jul 24, 2018 | |
| Robert E Johnston |
Corporate Director | Jan 29, 2025 | |
| Thomas J Zwingman |
Corporate Director | Nov 28, 2018 | |
| Diane M Brugger |
Corporate Officer |
Mar 1, 2019 | |
| W-2 Managing Employee |
Mar 1, 2019 | ||
| Operational/Managerial Control |
Mar 1, 2019 | ||
| James E Meuret |
Corporate Officer | Jul 29, 2020 | |
| Corporate Director | Aug 1, 1995 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040709000331 | NE | Part a Provider - Rural Health Clinic | 5496733156 | Practice locations: Elgin, NE |
National Provider Directory
- Tax ID family
- Antelope Memorial Hosp
- Part of
- Antelope Memorial Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
101 West Cedar St
Elgin, NE 68636-4490
Mailing address
PO Box 109
Neligh, NE 68756-0109
Phone (402) 887-5440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025168800 | Medicaid | NE |
Other names
- AMH Elgin Clinic
Other providers in Elgin, NE
- Lori Beckman
- Boone County Health Center
- City of Elgin
- Elgin Public School
- Friendly Neighbor Healthcare, LLC
All providers in Elgin, NE · Rural Health Clinic/Center in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.