Provider Demographics
NPI:1194767285
Name:COMMUNITY MEDICAL CENTER, INC
Entity type:Organization
Organization Name:COMMUNITY MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHADWICK
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-245-6500
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-0399
Mailing Address - Country:US
Mailing Address - Phone:402-245-4475
Mailing Address - Fax:402-245-6651
Practice Address - Street 1:3307 BILL SCHOCK BLVD
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2428
Practice Address - Country:US
Practice Address - Phone:402-245-4475
Practice Address - Fax:402-245-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098457Medicare ID - Type Unspecified
NE283449Medicare Oscar/Certification