JENNIE M. MELHAM MEMORIAL MEDICAL CENTER-LTC - NPI 1093880072 - Nursing Facility/Intermediate Care Facility in Broken Bow, NE

Q: What is Jennie M Melham Memorial Medical Center's specialty?

The primary specialty registered for this NPI is Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.

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About Jennie M. Melham Memorial Medical Center-ltc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JENNIE M. MELHAM MEMORIAL MEDICAL CENTER-LTC (NPI 1093880072) is a healthcare organization registered as a nursing facility/intermediate care facility in Broken Bow, Nebraska and active in the NPI registry since November 2006. The organization holds a CLIA Certificate of Compliance certificate valid through May 3, 2027 and lists Timothy L Schuckman, Vice President-cfo, as its authorized official.

NPPES Registry Identity

NPI1093880072

Entity TypeOrganization

Primary Taxonomy313M00000X

Legal Business NameJENNIE M MELHAM MEMORIAL MEDICAL CENTER

Location Address145 MEMORIAL DRBroken Bow, NE 68822-1378

Mailing AddressPo Box 250Broken Bow, NE 68822-0250 · (308) 872-2625 · Fax (308) 872-6116

Phone(308) 872-2625

Fax(308) 872-6116

Organization SubpartNo

Authorized OfficialTimothy L SchuckmanVice President-cfo · (307) 872-2625

Enumeration DateNovember 22, 2006

Last NPPES UpdateJanuary 10, 20202 updates tracked since enumeration

✔ NPI 1093880072 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNursing Facility/Intermediate Care FacilityNursing & Custodial Care Facilities

Taxonomy Code313M00000X

License✔ Licensed in NE · LTCH004

Definition

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

145 MEMORIAL DR, Broken Bow, NE 68822

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Other Names 1

Other NameJennie M. Melham Memorial Medical Center-ltc

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 28D0455865

Jennie M Melham Memorial Medical Center · Broken Bow, NE

Active · expires May 3, 2027

CLIA Number28D0455865

Laboratory TypeHospital

Certificate Effective DateMay 4, 2025

Certificate Expiration DateMay 3, 2027

Laboratory DirectorDr. Byron L. Barksdale

Laboratory Phone(308) 872-4131

Laboratory LocationJennie M Melham Memorial Medical Center145 Memorial Drive, Broken Bow, NE 68822

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JULIE A LINDSTROM D.O.

Family Medicine