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
275N00000X
Medicare Defined Swing Bed Hospital Unit
100004
NE
282NC0060X
Critical Access Hospital
Primary
100004
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0559
BLUE CROSS SWB NUMBER
—
Enumeration date
11/21/2006
Last updated
07/31/2023
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