Provider Demographics
NPI:1568545747
Name:MINNEOLA DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:MINNEOLA DISTRICT HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-885-4264
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:KS
Mailing Address - Zip Code:67865-0127
Mailing Address - Country:US
Mailing Address - Phone:620-885-4264
Mailing Address - Fax:620-885-4602
Practice Address - Street 1:212 MAIN ST
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:KS
Practice Address - Zip Code:67865-8511
Practice Address - Country:US
Practice Address - Phone:620-885-4264
Practice Address - Fax:620-885-4602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNEOLA DISTRICT HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH013002275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1627OtherBLUE CROSS SWING BED
KS55455Medicare PIN
KS55459Medicare PIN
KS43-54098-061Medicare PIN
17Z368Medicare Oscar/Certification
KS556862Medicare PIN
KS54522Medicare PIN