Provider Demographics
NPI:1376586578
Name:THE CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS
Entity Type:Organization
Organization Name:THE CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS
Other - Org Name:CLARA BARTON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TUSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-653-2114
Mailing Address - Street 1:250 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1706
Mailing Address - Country:US
Mailing Address - Phone:620-653-5067
Mailing Address - Fax:620-653-5070
Practice Address - Street 1:252 W 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1700
Practice Address - Country:US
Practice Address - Phone:620-653-2386
Practice Address - Fax:620-653-4186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARA BARTON HOSPITAL ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003913800003Medicaid
KS30003913800007Medicaid
KS100099000EMedicaid
KS110662Medicare PIN
KS110662OtherBCBS