Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1002 S 4th St, Kiowa, Kansas |
Authorized Official Name and Position | Janell Lyn Goodno (CFO) |
Authorized Official Contact | 6208254131 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
810 Drumm St Kiowa KS 67070-1626 Ph: (620) 825-4131 | 1002 S 4th St Kiowa KS 67070-1825 Ph: (620) 825-4131 |
NPI Number | 1093708596 |
---|---|
Provider Enumeration Date | 08/30/2005 |
Last Update Date | 11/02/2023 |
Medicare PECOS PAC ID | 8325020670 |
---|---|
Medicare Enrollment ID | O20041014000588 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093708596 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 178506 (Kansas) | Primary |
Kiowa District Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1002 S 4th St, Kiowa, KS 67070 Phone: 620-825-4131 Fax: 620-825-4753 |