Provider Demographics
NPI:1023027166
Name:MIDWEST DIVISION - ACH, LLC
Entity Type:Organization
Organization Name:MIDWEST DIVISION - ACH, LLC
Other - Org Name:ALLEN COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-1026
Mailing Address - Street 1:101 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3505
Mailing Address - Country:US
Mailing Address - Phone:620-365-1000
Mailing Address - Fax:620-365-1032
Practice Address - Street 1:101 S 1ST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3505
Practice Address - Country:US
Practice Address - Phone:620-365-1000
Practice Address - Fax:620-365-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health