Provider Demographics
NPI:1861787194
Name:AVERA ST ANTHONYS HOSPITAL
Entity type:Organization
Organization Name:AVERA ST ANTHONYS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONSBRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-336-2611
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-0270
Mailing Address - Country:US
Mailing Address - Phone:402-336-5154
Mailing Address - Fax:402-336-5137
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1519
Practice Address - Country:US
Practice Address - Phone:402-336-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERA ST ANTHONYS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-15
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026170000Medicaid
NE10026174900Medicaid
NENA1943Medicare PIN
NE10026174900Medicaid