Provider Demographics
NPI:1205845344
Name:ALLEN COUNTY KANSAS HOSPITAL
Entity Type:Organization
Organization Name:ALLEN COUNTY KANSAS HOSPITAL
Other - Org Name:ALLEN COUNTY REGIONAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-1026
Mailing Address - Street 1:826 E MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-3555
Mailing Address - Country:US
Mailing Address - Phone:620-365-2120
Mailing Address - Fax:620-365-2126
Practice Address - Street 1:826 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-3555
Practice Address - Country:US
Practice Address - Phone:620-365-2120
Practice Address - Fax:620-365-2126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEN COUNTY KANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-07
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
001472OtherBLUE CROSS HOSPICE
KS100457200CMedicaid
171541Medicare Oscar/Certification