Provider Demographics
NPI:1265485817
Name:CLAY COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:CLAY COUNTY MEDICAL CENTER
Other - Org Name:CLAY COUNTY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-632-2144
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-0512
Mailing Address - Country:US
Mailing Address - Phone:785-632-2144
Mailing Address - Fax:785-632-3352
Practice Address - Street 1:617 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1564
Practice Address - Country:US
Practice Address - Phone:785-632-2144
Practice Address - Fax:785-632-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH014001133V00000X, 208600000X, 251G00000X, 275N00000X, 282NC0060X, 363L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0949255Medicaid
KS100098830AMedicaid
CAXHSP32823Medicaid
NM000B2435Medicaid
KS00119OtherBLUE CROSS OF KS
CAXHSP42823Medicaid
KS171371Medicare Oscar/Certification