Basic Information
| Provider Information | |||||||||
| NPI: | 1255308045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAYS MEDICAL CENTER, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HMC - PEDIATRIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2220 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856235000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2214 CANTERBURY DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232360 | ||||||||
| FaxNumber: | 7856232371 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | MOORE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR, PHYSICIAN PRACTICES | ||||||||
| AuthorizedOfficialTelephone: | 7856232185 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 100267520A | 05 | KS | MEDICAID |