Basic Information
| Provider Information | |||||||||
| NPI: | 1760482517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1823 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857763322 | ||||||||
| FaxNumber: | 7857761988 | ||||||||
| Practice Location | |||||||||
| Address1: | 1823 COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857763322 | ||||||||
| FaxNumber: | 7857761988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 03/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | COPPLE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7857762831 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336I0012X | 2-09568 | KS | N | Suppliers | Pharmacy | Institutional Pharmacy | 282N00000X | H081003 | KS | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100265560A | 05 | KS | MEDICAID | 2142927 | 01 | PK | OTHER | 000024 | 01 | KS | BLUE CROSS | OTHER |