Provider Demographics
NPI:1922802669
Name:BRODSTONE MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BRODSTONE MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREG
Authorized Official - Middle Name:
Authorized Official - Last Name:VYZOUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-207-1516
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-0187
Mailing Address - Country:US
Mailing Address - Phone:402-879-3281
Mailing Address - Fax:402-879-3401
Practice Address - Street 1:5427 HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:NE
Practice Address - Zip Code:68340-9845
Practice Address - Country:US
Practice Address - Phone:402-207-1132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRODSTONE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-02
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health