Provider Demographics
NPI:1083668719
Name:AMBERWELL ATCHISON ASSOCIATION
Entity Type:Organization
Organization Name:AMBERWELL ATCHISON ASSOCIATION
Other - Org Name:AMBERWELL HEALTH SWING BED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-367-2131
Mailing Address - Street 1:800 RAVEN HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-9204
Mailing Address - Country:US
Mailing Address - Phone:913-367-2131
Mailing Address - Fax:913-367-2913
Practice Address - Street 1:800 RAVEN HILL DRIVE
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-9204
Practice Address - Country:US
Practice Address - Phone:913-367-2131
Practice Address - Fax:913-367-2913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBERWELL ATCHISON ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-003-001275N00000X
KSKSAH003001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17Z382Medicare Oscar/Certification