Provider Demographics
NPI:1114910114
Name:LINDSBORG COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:LINDSBORG COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER WEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-227-3308
Mailing Address - Street 1:605 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-2328
Mailing Address - Country:US
Mailing Address - Phone:785-227-3308
Mailing Address - Fax:785-227-4130
Practice Address - Street 1:605 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-2328
Practice Address - Country:US
Practice Address - Phone:785-227-3308
Practice Address - Fax:785-227-4130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDSBORG COMMUNITY HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-24
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH0059001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17Z358Medicare Oscar/Certification