1710086632 NPI number — SUSAN B. ALLEN MEMORIAL HOSPITAL

Table of content: (NPI 1710086632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710086632 NPI number — SUSAN B. ALLEN MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN B. ALLEN 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:
SUSAN B. ALLEN MEMORIAL HOSPITAL HOME MEDICAL EQUIPMENT
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:
1710086632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 W CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67042-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-321-3300
Provider Business Mailing Address Fax Number:
316-321-4810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67042-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-322-4549
Provider Business Practice Location Address Fax Number:
316-321-4912
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CEO
Authorized Official Telephone Number:
316-322-4518

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100009270A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 48582 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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