Basic Information
| Provider Information | |||||||||
| NPI: | 1619952785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALINA REGIONAL HEALTH CENTER, INC | ||||||||
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| OtherOrganizationName: | PHYSICIAN PRACTICE MANAGEMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S SANTA FE AVE | ||||||||
| Address2: | SRHC REVENUE CYCLE MGMT | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854527269 | ||||||||
| FaxNumber: | 7854526008 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S SANTA FE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854527269 | ||||||||
| FaxNumber: | 7854526008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | WIKOFF | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7854526152 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SALINA REGIONAL HEALTH CENTER, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 207RC0200X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RH0003X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RP1001X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207T00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery | 207V00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207X00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2084N0400X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084P0800X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208G00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208M00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 213E00000X | KS | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 332900000X | N | Suppliers | Non-Pharmacy Dispensing Site | 208600000X | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100105940C | 05 | KS | MEDICAID |