Basic Information
| Provider Information | |||||||||
| NPI: | 1457454787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TREGO COUNTY LEMKE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 N 13TH ST | ||||||||
| Address2: | |||||||||
| City: | WAKEENEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676722002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857432182 | ||||||||
| FaxNumber: | 7857436317 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 N 13TH ST | ||||||||
| Address2: | |||||||||
| City: | WAKEENEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676722002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857432182 | ||||||||
| FaxNumber: | 7857436317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 03/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7857432182 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TREGO COUNTY LEMKE MEMORIAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | A-098-001 | KS | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 100018310B | 05 | KS | MEDICAID |