Basic Information
Provider Information | |||||||||
NPI: | 1164928347 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MIAMI COUNTY MEDICAL CENTER INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OLATHE HEALTH FAMILY MEDICINE-PAOLA | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2100 BAPTISTE DR | ||||||||
Address2: |   | ||||||||
City: | PAOLA | ||||||||
State: | KS | ||||||||
PostalCode: | 660711314 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9132942327 | ||||||||
FaxNumber: | 9132949897 | ||||||||
Practice Location | |||||||||
Address1: | 1318 KANSAS DR | ||||||||
Address2: |   | ||||||||
City: | PAOLA | ||||||||
State: | KS | ||||||||
PostalCode: | 660712107 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9135575678 | ||||||||
FaxNumber: | 9135575681 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/05/2018 | ||||||||
LastUpdateDate: | 04/05/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WIENS | ||||||||
AuthorizedOfficialFirstName: | CATHERINE | ||||||||
AuthorizedOfficialMiddleName: | R. | ||||||||
AuthorizedOfficialTitleorPosition: | VP/QUALITY & COMPLIANCE | ||||||||
AuthorizedOfficialTelephone: | 9137914459 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | MIAMI COUNTY MEDICAL CENTER INC. | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.