Provider Demographics
NPI:1093708596
Name:KIOWA DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:KIOWA DISTRICT HOSPITAL
Other - Org Name:KIOWA DISTRICT HOSPITAL-CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:GOODNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-825-4131
Mailing Address - Street 1:810 DRUMM ST
Mailing Address - Street 2:
Mailing Address - City:KIOWA
Mailing Address - State:KS
Mailing Address - Zip Code:67070-1626
Mailing Address - Country:US
Mailing Address - Phone:620-825-4131
Mailing Address - Fax:620-825-4667
Practice Address - Street 1:1002 S 4TH ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:KS
Practice Address - Zip Code:67070-1825
Practice Address - Country:US
Practice Address - Phone:620-825-4131
Practice Address - Fax:620-825-4667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIOWA DISTRICT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-30
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS178506261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178506Medicare Oscar/Certification