Organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER
Active
Other names
Custer County Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY L SCHUCKMAN (VICE PRESIDENT-CFO)
(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
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00368
BLUE CROSS HOSPICE NUMBER
—
05
—
10025136500
—
NE
Enumeration date
11/21/2006
Last updated
01/10/2020
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