Provider Demographics
NPI:1326088972
Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Entity Type:Organization
Organization Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Other - Org Name:SATANTA RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINGENPEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-649-2761
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-0159
Mailing Address - Country:US
Mailing Address - Phone:620-649-2761
Mailing Address - Fax:620-649-2776
Practice Address - Street 1:401 CHEYENNE STREET
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-0159
Practice Address - Country:US
Practice Address - Phone:620-649-2761
Practice Address - Fax:620-649-2776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-091863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1711476OtherNCPDP#
KS100080490EMedicaid
KS100080490FMedicaid
KS051144OtherBLUE CROSS #
KS051144OtherBLUE CROSS #