Provider Demographics
NPI:1023199908
Name:MINNEOLA DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:MINNEOLA DISTRICT HOSPITAL
Other - Org Name:MINNEOLA DISTRICT HOSPITAL LONG TERM CARE UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-885-4264
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:KS
Mailing Address - Zip Code:67865-0127
Mailing Address - Country:US
Mailing Address - Phone:620-885-4238
Mailing Address - Fax:620-885-4479
Practice Address - Street 1:207 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:KS
Practice Address - Zip Code:67865-8511
Practice Address - Country:US
Practice Address - Phone:620-885-4238
Practice Address - Fax:620-885-4479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNEOLA DISTRICT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17E470313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200251270AMedicaid