Provider Demographics
NPI:1083633374
Name:WILLIAM NEWTON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WILLIAM NEWTON MEMORIAL HOSPITAL
Other - Org Name:DEXTER COMMUNITY RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-758-2221
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:204 NORTH MAIN
Mailing Address - City:DEXTER
Mailing Address - State:KS
Mailing Address - Zip Code:67038-0240
Mailing Address - Country:US
Mailing Address - Phone:620-876-5863
Mailing Address - Fax:620-876-5865
Practice Address - Street 1:204 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:KS
Practice Address - Zip Code:67038
Practice Address - Country:US
Practice Address - Phone:620-876-5863
Practice Address - Fax:620-876-5865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM NEWTON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS173433261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100005090HMedicaid
173433Medicare Oscar/Certification