Provider Demographics
NPI:1063009819
Name:KIOWA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:KIOWA COUNTY MEMORIAL HOSPITAL
Other - Org Name:GREENSBURG FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-723-4203
Mailing Address - Street 1:721 W KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67054-1633
Mailing Address - Country:US
Mailing Address - Phone:620-723-3341
Mailing Address - Fax:
Practice Address - Street 1:721 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-1633
Practice Address - Country:US
Practice Address - Phone:620-723-3341
Practice Address - Fax:620-508-2067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIOWA COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100303090CMedicaid
KS30003956420007Medicaid