Provider Demographics
NPI:1518394147
Name:PAWNEE VALLEY COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:PAWNEE VALLEY COMMUNITY HOSPITAL INC
Other - Org Name:PAWNEE VALLEY COMMUNITY HOSPITAL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-623-5523
Mailing Address - Street 1:713 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:713 W 11TH ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2055
Practice Address - Country:US
Practice Address - Phone:620-804-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178581Medicare Oscar/Certification