Provider Demographics
NPI:1538264403
Name:WARREN MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:WARREN MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-947-2541
Mailing Address - Street 1:905 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:FRIEND
Mailing Address - State:NE
Mailing Address - Zip Code:68359-1133
Mailing Address - Country:US
Mailing Address - Phone:402-947-2541
Mailing Address - Fax:402-947-2811
Practice Address - Street 1:905 2ND STREET
Practice Address - Street 2:
Practice Address - City:FRIEND
Practice Address - State:NE
Practice Address - Zip Code:68359-1133
Practice Address - Country:US
Practice Address - Phone:402-947-2541
Practice Address - Fax:402-947-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2024-03-29
Deactivation Date:2024-02-07
Deactivation Code:
Reactivation Date:2024-03-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE54901Medicaid