NPIMap

Organization Active NPI

Cambridge Memorial Hospital Inc

Doing business as Indianola Medical Clinic

  • Rural Health Clinic/Center
  • Indianola, NE
National Provider Identifier
1316034846
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CAMBRIDGE MEMORIAL HOSPITAL INC
Doing business as
Indianola Medical Clinic
Practice address
119 South 4TH
Indianola, NE 69034
Phone
(308) 697-1419
Fax
(308) 697-4176
NPI assigned
Oct 6, 2006
Last updated
Mar 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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

Authorized official

Name
Deborah Herzberg
Title
Ceo
Phone
(308) 697-3329

Specialties & licenses 1

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

Addresses

Primary practice location

119 South 4TH
Indianola, NE 69034

Mailing address

PO Box 488
Cambridge, NE 69022
Phone (308) 697-1526

Other names 1

  • Indianola Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061115000340 NE Part A Provider - Rural Health Clinic 2466346077 Practice locations: Indianola, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316034846. Details of each certification follow.

Rural health clinic certification: CCN 283985

Legal name
CAMBRIDGE MEMORIAL HOSPITAL INC
Doing business as
INDIANOLA MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 2, 1992
Last certification
Dec 9, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
119 S 4TH Street
Indianola, NE 69034-6607
Related CCNs
281348

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

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0665558Indianola Medical Clinic119 South 4TH, Indianola, NE 69034Certificate of waiverJul 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Tri Valley Health Syste8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Lavern Banzhaf Individual Corporate DirectorBoard of Director Oct 1, 2018
Clay M Jordan Individual Corporate OfficerCeo Nov 29, 2023
Julie Schultz Individual W-2 Managing EmployeeDirector of Patient Accounting Oct 7, 2002
Bethany M Marintzer Individual Corporate OfficerCfo Aug 18, 2025
John Paulsen Individual Corporate DirectorBoard of Director Apr 1, 2019
James McGowen Individual Corporate DirectorDirector Oct 31, 2022

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425254400000",
    "number": "1316034846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "city": "CAMBRIDGE",
            "state": "NE",
            "postal_code": "69022",
            "telephone_number": "308-697-1526",
            "fax_number": "308-697-3278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SOUTH 4TH",
            "city": "INDIANOLA",
            "state": "NE",
            "postal_code": "69034",
            "telephone_number": "308-697-1419",
            "fax_number": "308-697-4176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMBRIDGE MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2015-03-02",
        "status": "A",
        "authorized_official_last_name": "HERZBERG",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "308-697-3329"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indianola Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianola, NE

Sources for this page

Verify at the official NPI Registry.