Provider Demographics
NPI:1285635425
Name:HANOVER HOSPITAL
Entity Type:Organization
Organization Name:HANOVER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTNI
Authorized Official - Middle Name:
Authorized Official - Last Name:OEHMKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MLS(ASCP)
Authorized Official - Phone:785-337-2214
Mailing Address - Street 1:205 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:KS
Mailing Address - Zip Code:66945-8924
Mailing Address - Country:US
Mailing Address - Phone:785-337-2214
Mailing Address - Fax:785-337-2727
Practice Address - Street 1:205 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:KS
Practice Address - Zip Code:66945-8924
Practice Address - Country:US
Practice Address - Phone:785-337-2214
Practice Address - Fax:785-337-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X, 261QR1300X, 341600000X
KSH101001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098950AMedicaid
KS000197OtherBLUE CROSS BLUE SHIELD
KS100098950CMedicaid
KS100098950CMedicaid