1528026291 NPI number — NINNESCAH VALLEY HEALTH SYSTEMS, INC.

Table of content: (NPI 1528026291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528026291 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:
KINGMAN HEALTHCARE CENTER
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:
1528026291
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:
PO BOX 376
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:
67068-0376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-532-3147
Provider Business Mailing Address Fax Number:
620-532-0167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 W D AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGMAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67068-1266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-532-3147
Provider Business Practice Location Address Fax Number:
620-532-0167
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
THAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
620-532-3147

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  H048001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC0060X , with the licence number: H048001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 30003916630001 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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