Provider Demographics
NPI:1003859521
Name:GRISELL MEMORIAL HOSPITAL DISTRICT 1
Entity Type:Organization
Organization Name:GRISELL MEMORIAL HOSPITAL DISTRICT 1
Other - Org Name:GRISELL MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-731-2231
Mailing Address - Street 1:210 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RANSOM
Mailing Address - State:KS
Mailing Address - Zip Code:67572-9525
Mailing Address - Country:US
Mailing Address - Phone:785-731-2231
Mailing Address - Fax:785-731-2895
Practice Address - Street 1:210 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:RANSOM
Practice Address - State:KS
Practice Address - Zip Code:67572-9525
Practice Address - Country:US
Practice Address - Phone:785-731-2231
Practice Address - Fax:785-731-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH068002275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001638OtherBLUE CROSS BLUE SHIELD
KS001638OtherBLUE CROSS BLUE SHIELD