Provider Demographics
NPI:1114961174
Name:CLAY COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-632-2144
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-0512
Mailing Address - Country:US
Mailing Address - Phone:785-632-2144
Mailing Address - Fax:785-632-3352
Practice Address - Street 1:617 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1564
Practice Address - Country:US
Practice Address - Phone:785-632-2144
Practice Address - Fax:785-632-3352
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAY COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012081OtherBLUE SHIELD GROUP CRNA