BRODSTONE MEMORIAL HOSPITAL — NPI 1073590626 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in SUPERIOR, NE)

CMS-1500 Box 24J / 33a • NPI

1073590626

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR1300X (CMS B4[14])

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

525 E 11TH ST, SUPERIOR, NE, 68978-1101

✓ 9-Digit EDI 837 ZIP+4 (68978-1101)

Practice Phone & Referral Fax

(402) 879-4781

Fax: (402) 879-3365

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1073590626 (BRODSTONE MEMORIAL HOSPITAL) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1073590626` (NPI-2 Organization / Facility)
Provider / Legal Name	BRODSTONE MEMORIAL HOSPITAL
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR1300X` (Clinic/Center, Rural Health)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	525 E 11TH ST, SUPERIOR, NE, 68978-1101
Practice Telephone / Fax	Tel: (402) 879-4781 \| Fax: (402) 879-3365
Administrative Mailing Address	PO BOX 407, SUPERIOR, NE, 68978-0407
Enumeration & Last Sync	Enumerated: 2005-12-26 \| CMS Record Updated: 2025-02-12
Authorized Official	TREG VYZOUREK (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

525 E 11TH ST, SUPERIOR, NE, 68978-1101

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Plain-English Taxonomy & CMS Crosswalk (261QR1300X)

What Does Taxonomy Code 261QR1300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR1300X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code B4[14] (Rural Health Clinic)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BRODSTONE MEMORIAL HOSPITAL)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207Q00000X` — Family Medicine Plain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor)	State: N/A \| License: `Verified` \| Primary: Secondary
`207R00000X` — Internal Medicine Plain English: Board-Certified Internist (Adult Diagnostic & Chronic Disease Physician)	State: N/A \| License: `Verified` \| Primary: Secondary
`207RE0101X` — Internal Medicine, Endocrinology, Diabetes & Metabolism Plain English: Board-Certified Endocrinologist (Diabetes, Thyroid & Hormone Specialist)	State: N/A \| License: `Verified` \| Primary: Secondary
`207T00000X` — Neurological Surgery Plain English: Board-Certified Neurosurgeon (Brain, Cranial & Spine Surgeon)	State: N/A \| License: `Verified` \| Primary: Secondary
`2084A2900X` — Psychiatry & Neurology, Neurocritical Care Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: N/A \| License: `Verified` \| Primary: Secondary
`2084N0400X` — Psychiatry & Neurology, Neurology Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: N/A \| License: `Verified` \| Primary: Secondary
`2084V0102X` — Psychiatry & Neurology, Vascular Neurology Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: N/A \| License: `Verified` \| Primary: Secondary
`208M00000X` — Hospitalist Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Hospitalist	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR1300X` — Clinic/Center, Rural Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: N/A \| License: `Verified` \| Primary: Secondary
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: N/A \| License: `Verified` \| Primary: Secondary

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BRODSTONE MEMORIAL HOSPITAL (NPI #1073590626)