Provider Demographics
NPI:1194822379
Name:GEORGETOWN HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:GEORGETOWN HEALTH CARE CENTER, INC.
Other - Org Name:GEORGETOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:WALL
Authorized Official - Last Name:HENDERSHOT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:913-362-0313
Mailing Address - Street 1:5605 MERRIAM DR
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-2521
Mailing Address - Country:US
Mailing Address - Phone:913-362-0313
Mailing Address - Fax:913-722-1600
Practice Address - Street 1:5605 MERRIAM DR
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-2521
Practice Address - Country:US
Practice Address - Phone:913-362-0313
Practice Address - Fax:913-722-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-10027332B00000X, 332BP3500X, 332BX2000X, 3336C0003X, 3336C0004X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100436590AMedicaid
KS1700978OtherNABP
KS1700978OtherNABP
0279830001Medicare NSC
MO601347008Medicaid