Provider Demographics
NPI:1528040953
Name:OSAWATOMIE STATE HOSPITAL
Entity Type:Organization
Organization Name:OSAWATOMIE STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUFICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-755-7228
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-0500
Mailing Address - Country:US
Mailing Address - Phone:913-755-7000
Mailing Address - Fax:913-755-7127
Practice Address - Street 1:500 HOSPTIAL DR
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-0500
Practice Address - Country:US
Practice Address - Phone:913-755-7000
Practice Address - Fax:913-755-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSM061101283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014099Medicare ID - Type UnspecifiedMEDICARE PART B
KS174004Medicare Oscar/Certification