Basic Information
| Provider Information | |||||||||
| NPI: | 1588657928 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WAMEGO HOSPITAL ASSOCIATION | ||||||||
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| OtherOrganizationName: | WAMEGO HEALTH CENTER AND WAMEGO FAMILY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 THORN DR | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672262709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162685178 | ||||||||
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| Practice Location | |||||||||
| Address1: | 711 GENN DR | ||||||||
| Address2: | |||||||||
| City: | WAMEGO | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854562295 | ||||||||
| FaxNumber: | 7854569467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | LAND | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7854562295 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | H-075-002 | KS | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 0000144576 | 01 | KS | BLUE CROSS/CRNA # | OTHER | 000098 | 01 | KS | BLUE CROSS PROVIDER # | OTHER | 000144577 | 01 | KS | BLUE CROSS/C. ROSE CRNA | OTHER | 100420870A | 05 | KS | MEDICAID | 000144683 | 01 | KS | CHERLY BROWN CRNA B/C PR# | OTHER | 100244410D | 05 | KS | MEDICAID | H-075-002 | 01 | KS | MED. FACILITY LICENSE # | OTHER |