Provider Demographics
NPI:1013222629
Name:DECATUR HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:DECATUR HEALTH SYSTEMS INC
Other - Org Name:DECATUR HEALTH SYSTEMS FAMILY PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-475-2208
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-0268
Mailing Address - Country:US
Mailing Address - Phone:785-475-2208
Mailing Address - Fax:785-475-2453
Practice Address - Street 1:902 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2412
Practice Address - Country:US
Practice Address - Phone:785-475-2015
Practice Address - Fax:785-475-3847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECATUR HEALTH SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-09
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X, 363L00000X
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178564Medicare Oscar/Certification
KS178904Medicare PIN