Basic Information
| Provider Information | |||||||||
| NPI: | 1447576178 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPITAL DISTRICT #1 OF CRAWFORD C | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | GIRARD MEDICAL CENTER DME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667432000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207248291 | ||||||||
| FaxNumber: | 6207246332 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667432000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207248291 | ||||||||
| FaxNumber: | 6207246332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2010 | ||||||||
| LastUpdateDate: | 04/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOYD | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6207248291 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | H019001 | KS | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 100004200D | 05 | KS | MEDICAID |