Basic Information
| Provider Information | |||||||||
| NPI: | 1710133269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. JOSEPH MEMORIAL HOSPITAL, INC. | ||||||||
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| OtherOrganizationName: | ST. JOSEPH FAMILY MEDICINE - LARNED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 970 | ||||||||
| Address2: | |||||||||
| City: | GREAT BEND | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675300970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207866475 | ||||||||
| FaxNumber: | 6207866155 | ||||||||
| Practice Location | |||||||||
| Address1: | 713 W 11TH ST | ||||||||
| Address2: | |||||||||
| City: | LARNED | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675502055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202856958 | ||||||||
| FaxNumber: | 6202852173 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 03/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | LIND | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6207866643 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.