Provider Demographics
NPI:1366452732
Name:COUNTY OF KIOWA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:COUNTY OF KIOWA HOSPITAL DISTRICT
Other - Org Name:WEISBROD HOSPITAL AND NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-438-5401
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:CO
Mailing Address - Zip Code:81036-0817
Mailing Address - Country:US
Mailing Address - Phone:719-438-5401
Mailing Address - Fax:719-438-5697
Practice Address - Street 1:1208 LUTHER STREET
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:CO
Practice Address - Zip Code:81036
Practice Address - Country:US
Practice Address - Phone:719-438-5401
Practice Address - Fax:719-438-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO361282NC0060X, 282NC0060X
CO1003313M00000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000144433Medicaid
CO061300Medicare PIN
CO06Z300Medicare PIN