Provider Demographics
NPI:1144770298
Name:LINDSBORG COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:LINDSBORG COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:LINDSBORG COMMUNITY HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
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 1:3715 10TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3542
Practice Address - Country:US
Practice Address - Phone:620-792-7868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDSBORG COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-12
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-059-001207Q00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016774OtherMEDICARE ID - TYPE UNSPECIFIED