1689601007 NPI number — MORTON COUNTY HOSPITAL

Table of content: (NPI 1689601007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689601007 NPI number — MORTON COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MORTON COUNTY 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:
MORTON COUNTY HOSPITAL PC
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:
1689601007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 937
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67950-0937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-697-2141
Provider Business Mailing Address Fax Number:
620-697-4766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
445 HILLTOP STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-697-2141
Provider Business Practice Location Address Fax Number:
620-697-4766
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
620-697-2141

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  H065001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: H065001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: H065001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: H065001 , 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: 100087540B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000190 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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