Provider Demographics
NPI:1457454787
Name:TREGO COUNTY LEMKE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:TREGO COUNTY LEMKE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-743-2182
Mailing Address - Street 1:320 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672-2002
Mailing Address - Country:US
Mailing Address - Phone:785-743-2182
Mailing Address - Fax:785-743-6317
Practice Address - Street 1:320 N 13TH ST
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672-2002
Practice Address - Country:US
Practice Address - Phone:785-743-2182
Practice Address - Fax:785-743-6317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREGO COUNTY LEMKE MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-098-001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100018310BMedicaid