Provider Demographics
NPI:1194753889
Name:COMMUNITY HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-344-8315
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-1328
Mailing Address - Country:US
Mailing Address - Phone:308-344-8303
Mailing Address - Fax:308-344-8572
Practice Address - Street 1:711 E 11TH ST
Practice Address - Street 2:STE A
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3692
Practice Address - Country:US
Practice Address - Phone:308-344-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-29
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE651001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
00530OtherBLUE CROSS
00530OtherBLUE CROSS
NE287106Medicare Oscar/Certification