Basic Information
| Provider Information | |||||||||
| NPI: | 1912935552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPITAL DISTRICT NO 1 CRAWFORD COUNTY | ||||||||
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| OtherOrganizationName: | GIRARD MEDICAL CENTER OF CHEROKEE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667432000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207248291 | ||||||||
| FaxNumber: | 6207246332 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 NW HWY 400 | ||||||||
| Address2: | |||||||||
| City: | CHEROKEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667240000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204578101 | ||||||||
| FaxNumber: | 6204578103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 10/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | KOCH | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6207248291 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H-019-001 | KS | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | H-019-001 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 100004200J | 05 | KS | MEDICAID |