Provider Demographics
NPI:1417901927
Name:KIOWA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:KIOWA COUNTY MEMORIAL HOSPITAL
Other - Org Name:GREENSBURG FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-723-4203
Mailing Address - Street 1:721 W KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67054-1633
Mailing Address - Country:US
Mailing Address - Phone:620-723-2127
Mailing Address - Fax:620-723-2127
Practice Address - Street 1:721 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-1633
Practice Address - Country:US
Practice Address - Phone:620-723-2127
Practice Address - Fax:620-508-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X, 363A00000X
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003956420009Medicaid
KS100409390EMedicaid
KS110749Medicare ID - Type UnspecifiedPART B