Basic Information
| Provider Information | |||||||||
| NPI: | 1700824398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIAMI COUNTY MEDICAL CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MIAMI COUNTY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 BAPTISTE DR | ||||||||
| Address2: | |||||||||
| City: | PAOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660711314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132942327 | ||||||||
| FaxNumber: | 9132949897 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 BAPTISTE DR | ||||||||
| Address2: | |||||||||
| City: | PAOLA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660711314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132942327 | ||||||||
| FaxNumber: | 9132949897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 09/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | GRASSER | ||||||||
| AuthorizedOfficialFirstName: | TIERNEY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP/CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9137914461 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | H061001 | KS | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100099280A | 05 | KS | MEDICAID |