1437542073 NPI number — NINNESCAH VALLEY HEALTH SYSTEMS INC

Table of content: (NPI 1437542073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437542073 NPI number — NINNESCAH VALLEY HEALTH SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NINNESCAH VALLEY HEALTH SYSTEMS INC
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:
CUNNINGHAM CLINIC
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:
1437542073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 W D AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGMAN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67068-1266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-532-0295
Provider Business Mailing Address Fax Number:
855-290-4906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUNNINGHAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67035-8802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-532-0295
Provider Business Practice Location Address Fax Number:
855-290-4906
Provider Enumeration Date:
03/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DROSSELMEYER
Authorized Official First Name:
LACY
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE SPECIALIST
Authorized Official Telephone Number:
620-532-0281

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30003916630005 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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