1720357700 NPI number — HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS

Table of content: (NPI 1720357700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720357700 NPI number — HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
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:
ABILENE FAMILY PHYSICIANS
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:
1720357700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 NE 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67410-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-263-2100
Provider Business Mailing Address Fax Number:
785-263-7390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 NE 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67410-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-263-7190
Provider Business Practice Location Address Fax Number:
785-263-7390
Provider Enumeration Date:
12/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COURTOIS
Authorized Official First Name:
REGINALD
Authorized Official Middle Name:
HAROLD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
785-263-6610

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 021-01 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100054360D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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