Provider Demographics
NPI:1285634006
Name:FREDONIA REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:FREDONIA REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-378-6204
Mailing Address - Street 1:1527 MADISON
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-0579
Mailing Address - Country:US
Mailing Address - Phone:620-378-2121
Mailing Address - Fax:620-378-3169
Practice Address - Street 1:1527 MADISON ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1751
Practice Address - Country:US
Practice Address - Phone:620-378-2121
Practice Address - Fax:620-378-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
KSH103001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5698OtherBCBS AMBULANCE
KS305OtherBCBS ACUTE IPOP
KS100102250BMedicaid
KS14075OtherBCBS ER PHY
KS100102550AMedicaid
KS100102550DMedicaid
KS12209OtherBCBS CRNA
KS14075OtherBCBS ER PHY
KS17Z374Medicare Oscar/Certification