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Organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER
Active
Organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER
Active
Other names
Jennie M. Melham Memorial Medical Center Home Health Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE D KELLUM (CEO AND PRESIDENT)
(308) 872-2625
Entity
Organization
Contact information
Practice address
145 MEMORIAL DR, BROKEN BOW, NE 68822-1378
(308) 872-2625
(308) 872-6116
Mailing address
PO BOX 250, BROKEN BOW, NE 68822-0250
(308) 872-2625
(308) 872-6116
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
101001
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0319
BLUE CROSS PROVIDER NUMBE
—
Enumeration date
11/22/2006
Last updated
07/31/2023
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