Organization
JENNIE M MELHAM MEMORIAL MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
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
282NC0060X
Critical Access Hospital
Primary
100004
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019
BLUE CROSS PROVIDER NUMBE
—
Enumeration date
11/17/2006
Last updated
07/31/2023
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