Provider Demographics
NPI:1063467868
Name:HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
Entity Type:Organization
Organization Name:HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
Other - Org Name:MEMORIAL HOSPITAL PROFESSIONAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:COURTOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-263-6610
Mailing Address - Street 1:511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2153
Mailing Address - Country:US
Mailing Address - Phone:785-263-2100
Mailing Address - Fax:785-263-6677
Practice Address - Street 1:511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2153
Practice Address - Country:US
Practice Address - Phone:785-263-2100
Practice Address - Fax:785-263-6677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363A00000X, 363L00000X
KST-01667208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty