Provider Demographics
NPI:1467594366
Name:GOODLAND REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GOODLAND REGIONAL MEDICAL CENTER
Other - Org Name:GOODLAND FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS/PT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-890-6012
Mailing Address - Street 1:106 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735
Mailing Address - Country:US
Mailing Address - Phone:785-890-6075
Mailing Address - Fax:785-890-6077
Practice Address - Street 1:106 WILLOW RD
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735
Practice Address - Country:US
Practice Address - Phone:785-890-6075
Practice Address - Fax:785-890-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088450EMedicaid
KS111003OtherBLUE CROSS BLUE SHIELD
KS111003OtherBLUE CROSS BLUE SHIELD