Provider Demographics
NPI:1336256064
Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-461-5108
Mailing Address - Street 1:715 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4451
Mailing Address - Country:US
Mailing Address - Phone:402-462-4380
Mailing Address - Fax:402-462-4418
Practice Address - Street 1:2115 N KANSAS AVE STE 106
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2625
Practice Address - Country:US
Practice Address - Phone:402-460-5839
Practice Address - Fax:402-460-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========80Medicaid
NE099055Medicare PIN