Provider Demographics
NPI:1093821514
Name:HODGEMAN COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:HODGEMAN COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-357-8361
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:JETMORE
Mailing Address - State:KS
Mailing Address - Zip Code:67854-0310
Mailing Address - Country:US
Mailing Address - Phone:620-357-8361
Mailing Address - Fax:620-357-6120
Practice Address - Street 1:809 W BRAMLEY ST
Practice Address - Street 2:
Practice Address - City:JETMORE
Practice Address - State:KS
Practice Address - Zip Code:67854-9320
Practice Address - Country:US
Practice Address - Phone:620-357-8361
Practice Address - Fax:620-357-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSHO42001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17Z369Medicare Oscar/Certification