Provider Demographics
NPI:1053515874
Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-461-5108
Mailing Address - Street 1:715 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4497
Mailing Address - Country:US
Mailing Address - Phone:402-463-4521
Mailing Address - Fax:402-461-5321
Practice Address - Street 1:715 N KANSAS AVE STE 204
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4438
Practice Address - Country:US
Practice Address - Phone:402-461-5358
Practice Address - Fax:402-461-5368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-14
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025523000Medicaid
NE099978Medicare PIN