Organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Active
Parent organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Authorized official
KYLE D KELLUM (CEO AND PRESIDENT)
(308) 872-4100
Entity
Organization
Contact information
Practice address
145 MEMORIAL DR, BROKEN BOW, NE 68822-1378
(308) 872-4100
(308) 872-4175
Mailing address
PO BOX 250, BROKEN BOW, NE 68822-0250
(308) 872-4100
(308) 872-4175
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07073
BLUE CROSS CRNA NUMBER
NE
05
—
10025055300
—
NE
01
—
81010
BLUE CROSS DIABETIC ED NO
NE
01
—
DB7316
RAILROAD MEDICARE NUMBER
NE
Enumeration date
05/16/2007
Last updated
07/31/2023
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