Provider Demographics
NPI:1154499812
Name:GOODLAND REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GOODLAND REGIONAL MEDICAL CENTER
Other - Org Name:GOODLAND FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS/PT ACCOUNTS MANGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-890-6012
Mailing Address - Street 1:106 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-1518
Mailing Address - Country:US
Mailing Address - Phone:785-890-6075
Mailing Address - Fax:785-890-6077
Practice Address - Street 1:106 WILLOW RD
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-1518
Practice Address - Country:US
Practice Address - Phone:785-890-6075
Practice Address - Fax:785-890-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH091001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00516OtherBLUE CROSS
KS100088450GMedicaid
KS100088450GMedicaid