Provider Demographics
NPI:1194944819
Name:JEFFERSON COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:JEFFERSON COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:JURGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-729-3351
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:FAIRBURY
Mailing Address - State:NE
Mailing Address - Zip Code:68352-0277
Mailing Address - Country:US
Mailing Address - Phone:402-729-3351
Mailing Address - Fax:402-729-2102
Practice Address - Street 1:2200 H ST
Practice Address - Street 2:
Practice Address - City:FAIRBURY
Practice Address - State:NE
Practice Address - Zip Code:68352-1119
Practice Address - Country:US
Practice Address - Phone:402-729-3351
Practice Address - Fax:402-729-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2505333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2805109Medicaid