Provider Demographics
NPI:1275531485
Name:GREENWOOD COUNTY HOSPITAL
Entity Type:Organization
Organization Name:GREENWOOD COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-583-7451
Mailing Address - Street 1:100 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:KS
Mailing Address - Zip Code:67045-1064
Mailing Address - Country:US
Mailing Address - Phone:620-583-5909
Mailing Address - Fax:620-583-5189
Practice Address - Street 1:100 W 16TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:KS
Practice Address - Zip Code:67045-1064
Practice Address - Country:US
Practice Address - Phone:620-583-5909
Practice Address - Fax:620-583-5189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENWOOD COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-037-002251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100070000CMedicaid
KS00855OtherHOME HEALTH PROVIDER #
KS100098920CMedicaid
KS100070000BMedicaid
KS100070000BMedicaid