Basic Information
| Provider Information | |||||||||
| NPI: | 1629186960 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TREGO COUNTY LEMKE MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | WAKEENEY FAMILY CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 333 N 14TH ST | ||||||||
| Address2: | |||||||||
| City: | WAKEENEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676723000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857432182 | ||||||||
| FaxNumber: | 7857436317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ADAMS-CLELAND | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7857432182 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TREGO COUNTY LEMKE MEMORIAL HOSPITAL | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | H-098-001 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 000608 | 01 | KS | BCBS RHC | OTHER | 100018310D | 05 | KS | MEDICAID | 12202 | 01 | KS | BCBS MD O/P PHYSICIAN | OTHER | 111158 | 01 | KS | BCBS MD | OTHER |