Basic Information
| Provider Information | |||||||||
| NPI: | 1154314656 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KIOWA DISTRICT HOSPITAL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | KIOWA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670701825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208254131 | ||||||||
| FaxNumber: | 6208254667 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 S 4TH ST | ||||||||
| Address2: | |||||||||
| City: | KIOWA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670701825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208254131 | ||||||||
| FaxNumber: | 6208254667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GOODNO | ||||||||
| AuthorizedOfficialFirstName: | JANELL | ||||||||
| AuthorizedOfficialMiddleName: | LYN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6208254131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | Y | Hospital Units | Medicare Defined Swing Bed Unit |
No ID Information.