Providence Medical Center
Organization Active NPI Critical Access Hospital · Wayne, NE
NPI 1801867494 · NPPES record last updated Mar 11, 2025
Key facts
- NPI
- 1801867494
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- PROVIDENCE MEDICAL CENTER
- Practice address
- 1200 Providence Road
Wayne, NE 68787-1212 - Phone
- (402) 375-7960
- Fax
- (402) 375-7989
- NPI assigned
- Jan 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Nicole Haglund
- Title
- Ceo
- Phone
- (402) 375-7954
Owners & managing parties with NPI records 4
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 4
Related certifications (CCN) 1
Practitioners 59
-
Kurtis Michael Hoefling, APRN
-
Lindsay Ryann Kvols, DNP
-
Michael N Lazarczyk, AU.D.
-
Ryan A Martin, MD
-
Radu Florin Neamu, M.D.
-
Kevin J Reichmuth, M.D.
-
Trisha Goembel, CNP
-
Heather Rose Kreber, MSPAS, PA-C
-
Daniel Ames Olsen, D.O.
-
Rasha Alqadi, M.D.
-
Melissa Dobbins, D.O.
-
Griffith F Evans, M.D.
-
Rabih C Fahed, M.D.
-
Brian J Finley, MD
-
Makayla Lynn Garcia, FNP-C
-
Ross Stewart Hansen, P.A.C
-
Harvey A.J. Hopkins, M.D.
-
Jery Inbarasu, M.D.
Affiliated clinicians 74
-
Jeffry Ailes, M.D.
-
Enas Al Zaghal, M.D
-
Amber Rene Amick, ARPN-NP
-
Jason Raymond Bailey, D.P.M.
-
Jordan David Bowling, M.D.
-
Curtis R Burhoop, M.D.
-
Nathaniel Clark, APRN-CRNA
-
Mary A Curtis, M.D.
-
Sneha Dhakal, MD
-
Adam David Diediker, APRN
-
Melissa Dobbins, D.O.
-
Rabih C Fahed, M.D.
-
Zara Fatima, M.D
-
Zackary Bryan Gangwer, D.P.M.
-
Makayla Lynn Garcia, FNP-C
-
Mellissa R Glenn, NP
-
Ross Stewart Hansen, P.A.C
-
Tristan Layton Hartzell, M.D.
-
Kurtis Michael Hoefling, APRN
-
Muhammad Naser Imran, M.D.
-
Steven D Janssen, PA-C
-
Camille Ann Kantai, APRN
Medicare Care Compare: Hospital
- Listed as
- Providence Medical Center
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NE
Hospital certification: CCN 281345
- Legal name
- PROVIDENCE MEDICAL CENTER
- Doing business as
- PROVIDENCE MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- May 1, 2001
- Last certification
- Aug 8, 2024
- Beds
- 21
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1200 Providence Rd
Wayne, NE 68787-1212
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Matthew Ley |
Corporate Officer |
Jan 1, 2016 | |
| Providence Medical Center |
5% Or Greater Direct Ownership Interest | Mar 2, 2010 | 100% |
| Nicole Haglund |
Corporate Director |
Mar 1, 2025 | |
| W-2 Managing Employee |
Mar 1, 2025 | ||
| Brittany Peters |
Corporate Director | Jan 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041124000342 | NE | Part B Supplier - Clinic/Group Practice | 4587629928 |
Receives reassigned benefits from 56 practitioners 1 other NPI on this enrollment Practice locations: Wayne, NE |
| O20071129000010 | NE | Part a Provider - Critical Access Hospital | 4587629928 |
Receives reassigned benefits from 25 practitioners Practice locations: Laurel, NE; Wakefield, NE; Wayne, NE |
National Provider Directory
Locations
699 Cedar Ave
Laurel, NE 68745
Phone (402) 256-7637
308 Ash St
Wakefield, NE 68784
Phone (402) 287-1005
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 800001 | NE | |
| Critical Access Hospital | 282NC0060X | NE | Yes |
Addresses
Primary practice location
1200 Providence Road
Wayne, NE 68787-1212
Mailing address
1200 Providence Road
Wayne, NE 68787-1212
Phone (402) 375-7960
Other practice location 1
308 Ash St
Wakefield, NE 68784-5023
Phone (402) 287-1005
Other practice location 2
699 Cedar Ave
Laurel, NE 68745-1703
Phone (402) 256-9551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 800001 | Medicaid | NE |
Other providers in Wayne, NE
- Providence Medical Center
- Providence Medical Center
- Providence Medical Center
- Providence Medical Center
- Providence Medical Center
- R Way, Inc
- Erin Marie Raabe
- Emily Ramirez
- Makena M Ramirez
- Zachery Michael Randall
All providers in Wayne, NE · Critical Access Hospital in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2025. 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.