1215937263 NPI number — ELLSWORTH COUNTY MEDICAL CENTER

Table of content: (NPI 1215937263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215937263 NPI number — ELLSWORTH COUNTY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLSWORTH COUNTY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ECMC- RURAL HEALTH CLINIC WILSON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215937263
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 AYLWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67439-2541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-472-3111
Provider Business Mailing Address Fax Number:
785-472-5639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 AVENUE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-658-3688
Provider Business Practice Location Address Fax Number:
785-658-3618
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KIRKBRIDE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
785-472-3111

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30003930830001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1387 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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