Provider Demographics
NPI:1528010717
Name:HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
Entity Type:Organization
Organization Name:HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
Other - Org Name:MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:COURTOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-263-6610
Mailing Address - Street 1:511 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:KS
Mailing Address - Zip Code:67410-2153
Mailing Address - Country:US
Mailing Address - Phone:785-263-2100
Mailing Address - Fax:785-263-6606
Practice Address - Street 1:511 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:KS
Practice Address - Zip Code:67410-2153
Practice Address - Country:US
Practice Address - Phone:785-263-2100
Practice Address - Fax:785-263-6606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH 021 001275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001260OtherBCBS SWINGBED
KS100098760AMedicaid
KS17Z381Medicare Oscar/Certification