Provider Demographics
NPI:1548333214
Name:CAMBRIDGE MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:CAMBRIDGE MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-697-1126
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NE
Mailing Address - Zip Code:69022-0488
Mailing Address - Country:US
Mailing Address - Phone:308-697-3329
Mailing Address - Fax:308-697-3278
Practice Address - Street 1:1305 HIGHWAY 6/34
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NE
Practice Address - Zip Code:69022-6616
Practice Address - Country:US
Practice Address - Phone:308-697-3329
Practice Address - Fax:308-697-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE31001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE281348Medicare PIN