Provider Demographics
NPI:1164503249
Name:MEDICALODGES, INC.
Entity Type:Organization
Organization Name:MEDICALODGES, INC.
Other - Org Name:MEDICALODGES DOUGLASS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF FINANCIAL REPORTING
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-251-6700
Mailing Address - Street 1:619 S US HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:DOUGLASS
Mailing Address - State:KS
Mailing Address - Zip Code:67039-8321
Mailing Address - Country:US
Mailing Address - Phone:316-747-2157
Mailing Address - Fax:316-747-2084
Practice Address - Street 1:619 S US HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:DOUGLASS
Practice Address - State:KS
Practice Address - Zip Code:67039-8321
Practice Address - Country:US
Practice Address - Phone:316-747-2157
Practice Address - Fax:316-747-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN008001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100111480AMedicaid
KS0411980023Medicare ID - Type Unspecified
KS100111480AMedicaid