Basic Information
| Provider Information | |||||||||
| NPI: | 1659724524 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTON COUNTY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LOGAN CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 250 | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676540250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858773351 | ||||||||
| FaxNumber: | 7858772841 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LOGAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676469764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858773351 | ||||||||
| FaxNumber: | 7858772841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2016 | ||||||||
| LastUpdateDate: | 01/02/2018 | ||||||||
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| AuthorizedOfficialLastName: | FRACK | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7858773351 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | H-069-001 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.