Provider Demographics
NPI:1073568523
Name:CLAY COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CENTER
Other - Org Name:MEADOWLARK HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-632-2144
Mailing Address - Street 1:709 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-1528
Mailing Address - Country:US
Mailing Address - Phone:785-632-2225
Mailing Address - Fax:785-632-3557
Practice Address - Street 1:709 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1528
Practice Address - Country:US
Practice Address - Phone:785-632-2225
Practice Address - Fax:785-632-3557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH014001251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098830BMedicaid
KS912OtherBLUE SHIELD OF KS
KS171522Medicare Oscar/Certification