NPIMap

Organization Active NPI

Pender Community Hospital District

Doing business as Pender Medical Clinic PCMH

  • Family Medicine Physician
  • Pender, NE
National Provider Identifier
1265092142
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PENDER COMMUNITY HOSPITAL DISTRICT
Doing business as
Pender Medical Clinic PCMH
Practice address
958 Wellness Way Ste 1
Pender, NE 68047-4518
Phone
(402) 385-3033
Fax
(402) 385-4041
NPI assigned
Jun 13, 2019
Last updated
Oct 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PENDER COMMUNITY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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

Authorized official

Name
Laura J Gamble
Title
Ceo
Phone
(402) 385-3083

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

958 Wellness Way Ste 1
Pender, NE 68047-4518

Mailing address

PO Box 100
Pender, NE 68047-0100
Phone (402) 385-3033

Other names 1

  • Pender Medical Clinic PCMH Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pender Community District8 organizations share this tax ID, including this one
Part of
Pender Community District

Other organizations with this tax ID 7

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

Locations

958 Wellness Way
Ste 1
Pender, NE 68047
Phone (402) 385-3033

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665964800000",
    "number": "1265092142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680470100",
            "telephone_number": "402-385-3033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "958 WELLNESS WAY STE 1",
            "city": "PENDER",
            "state": "NE",
            "postal_code": "680474518",
            "telephone_number": "402-385-3033",
            "fax_number": "402-385-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDER COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENDER COMMUNITY HOSPITAL DISTRICT",
        "enumeration_date": "2019-06-13",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A",
        "authorized_official_last_name": "GAMBLE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-385-3083"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pender Medical Clinic PCMH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pender Medical Clinic PCMH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pender, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2022; 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.