Provider Demographics
NPI:1194830679
Name:TREGO COUNTY LEMKE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TREGO COUNTY LEMKE MEMORIAL HOSPITAL
Other - Org Name:ELLIS FAMILY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS-CLELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-743-2124
Mailing Address - Street 1:320 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-2002
Mailing Address - Country:US
Mailing Address - Phone:785-743-2182
Mailing Address - Fax:785-743-6317
Practice Address - Street 1:1000 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELLIS
Practice Address - State:KS
Practice Address - Zip Code:67637-1615
Practice Address - Country:US
Practice Address - Phone:785-726-4956
Practice Address - Fax:785-726-4479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREGO COUNTY LEMKE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-098-001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111217OtherBCBS MD
KS100018310EMedicaid
KS000434OtherBCBS RHC
KS178538Medicare Oscar/Certification