1003894122 NPI number — JOHNSON COUNTY MEMORIAL HOSPITAL

Table of content: (NPI 1003894122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003894122 NPI number — JOHNSON COUNTY MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON COUNTY MEMORIAL HOSPITAL
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:
Provider Other Organization Name Type Code:
6
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:
1003894122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
497 WEST LOTT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82834-1609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-684-6188
Provider Business Mailing Address Fax Number:
307-684-5385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
497 WEST LOTT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82834-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-684-6188
Provider Business Practice Location Address Fax Number:
307-684-5385
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SENDEN
Authorized Official First Name:
LUKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
307-684-6188

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  06140 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 275N00000X , with the licence number: 06140 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 06140 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 106561102 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106561110 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1106561111 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y415571 . This is a "WORKERS COMP & COMMERCIAL" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 106561104 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185689800 . This is a "WORKERS COMP & COMMERCIAL" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 007336 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 00984001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 530026 . This is a "WORKERS COMP & COMMERCIAL" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 106561100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185689800 . This is a "TRICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: Y415571 . This is a "TRICARE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com