Basic Information
| Provider Information | |||||||||
| NPI: | 1952652190 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLBY MEDICAL AND SURGICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 S RANGE AVE | ||||||||
| Address2: | |||||||||
| City: | COLBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677012931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854623332 | ||||||||
| FaxNumber: | 7854626956 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 S RANGE AVE | ||||||||
| Address2: | |||||||||
| City: | COLBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 677012931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854623332 | ||||||||
| FaxNumber: | 7854626956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2012 | ||||||||
| LastUpdateDate: | 09/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | HILDYARD | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7854623332 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-15836 | KS | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-15836 | 01 | LICENSE NUMBER | OTHER |