Provider Demographics
NPI:1003251802
Name:WILSON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:WILSON COUNTY HOSPITAL
Other - Org Name:INDEPENDENCE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTSCHENRITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-325-8388
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:1415 N. PENN AVE
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-0314
Mailing Address - Country:US
Mailing Address - Phone:620-331-2400
Mailing Address - Fax:620-331-2405
Practice Address - Street 1:1415 N PENN AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-2222
Practice Address - Country:US
Practice Address - Phone:620-331-2400
Practice Address - Fax:620-331-2405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-07
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012213OtherMEDICARE PART B PTAN