Basic Information
| Provider Information | |||||||||
| NPI: | 1801824123 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOB WILSON MEMORIAL GRANT COUNTY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 N MAIN | ||||||||
| Address2: | |||||||||
| City: | ULYSSES | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203561266 | ||||||||
| FaxNumber: | 6203566014 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 N MAIN | ||||||||
| Address2: | |||||||||
| City: | ULYSSES | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203561266 | ||||||||
| FaxNumber: | 6203566014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | FRABLE | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6203566048 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 275N00000X | HO34001 | KS | Y | Hospital Units | Medicare Defined Swing Bed Unit |
ID Information
| ID | Type | State | Issuer | Description | 100099420B | 05 | KS | MEDICAID | 10099420A | 05 | KS | MEDICAID | 001649 | 01 | KS | BLUE CROSS BLUE SHEILD | OTHER |