Provider Demographics
NPI:1508253501
Name:NINNESCAH VALLEY HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:NINNESCAH VALLEY HEALTH SYSTEMS INC
Other - Org Name:KINGMAN HEALTHCARE CENTER FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DROSSELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-532-0281
Mailing Address - Street 1:750 W D AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1266
Mailing Address - Country:US
Mailing Address - Phone:620-532-0295
Mailing Address - Fax:855-483-0002
Practice Address - Street 1:750 W D AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1266
Practice Address - Country:US
Practice Address - Phone:620-532-0295
Practice Address - Fax:855-483-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003916630006Medicaid