Basic Information
| Provider Information | |||||||||
| NPI: | 1366716342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL DISTRICT NO 1 OF RICE CO | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STERLING MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 S CLARK AVE | ||||||||
| Address2: | PO BOX 828 | ||||||||
| City: | LYONS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675543003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202575173 | ||||||||
| FaxNumber: | 6202572608 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 N BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675791916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202782123 | ||||||||
| FaxNumber: | 6202782712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | POUND | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6202575173 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOSPITAL DISTRICT NO 1 OF RICE CO | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H080001 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100099160A | 05 | KS | MEDICAID |