Provider Demographics
NPI:1376845651
Name:STEVENS COUNTY HOSPITAL
Entity Type:Organization
Organization Name:STEVENS COUNTY HOSPITAL
Other - Org Name:STEVENS COUNTY RETAIL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FEATHERSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-544-6178
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:HUGOTON
Mailing Address - State:KS
Mailing Address - Zip Code:67951-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1042 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGOTON
Practice Address - State:KS
Practice Address - Zip Code:67951-2842
Practice Address - Country:US
Practice Address - Phone:620-544-8512
Practice Address - Fax:620-544-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
KS2-130463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200681660AMedicaid
2031590OtherPK
2031590OtherPK
KS200681660AMedicaid