Provider Demographics
NPI:1093716623
Name:HERINGTON MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:HERINGTON MUNICIPAL HOSPITAL
Other - Org Name:HERINGTON AREA HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-258-2207
Mailing Address - Street 1:1005 N B STREET
Mailing Address - Street 2:
Mailing Address - City:HERINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67449-1600
Mailing Address - Country:US
Mailing Address - Phone:785-258-5130
Mailing Address - Fax:785-258-5129
Practice Address - Street 1:1005 N B STREET
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449-1600
Practice Address - Country:US
Practice Address - Phone:785-258-5130
Practice Address - Fax:785-258-5129
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERINGTON MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-04
Last Update Date:2012-07-06
Deactivation Date:2007-10-22
Deactivation Code:
Reactivation Date:2007-11-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100011610BMedicaid
KS100011610BMedicaid