Basic Information
| Provider Information | |||||||||
| NPI: | 1437215480 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WAMEGO HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WAMEGO FAMILY CLINIC & WAMEGO HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 GENN DR | ||||||||
| Address2: | |||||||||
| City: | WAMEGO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665471179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854562295 | ||||||||
| FaxNumber: | 7854569467 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 GENN DR | ||||||||
| Address2: | |||||||||
| City: | WAMEGO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854562295 | ||||||||
| FaxNumber: | 7854569467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | LAND | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7854562295 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | H-075-002 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 100420870-C | 05 | KS | MEDICAID | 001537-RHC | 01 | KS | BLUE CROSS | OTHER |