Provider Demographics
NPI:1902960313
Name:PENDER COMMUNITY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:PENDER COMMUNITY HOSPITAL DISTRICT
Other - Org Name:PENDER COMMUNITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-385-3083
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PENDER
Mailing Address - State:NE
Mailing Address - Zip Code:68047-0100
Mailing Address - Country:US
Mailing Address - Phone:402-385-4012
Mailing Address - Fax:402-385-1870
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PENDER
Practice Address - State:NE
Practice Address - Zip Code:68047-4507
Practice Address - Country:US
Practice Address - Phone:402-385-3083
Practice Address - Fax:402-385-1870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENDER COMMUNITY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH000120275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00281OtherBCBSNE CAH SWING BED
NE28Z349Medicare Oscar/Certification