Organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER
Active
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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008977
BLUE CROSS DME NUMBER
—
Enumeration date
11/21/2006
Last updated
01/10/2020
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