Provider Demographics
NPI:1588601587
Name:GRISELL MEMORIAL HOSPITAL DISTRICT 1
Entity Type:Organization
Organization Name:GRISELL MEMORIAL HOSPITAL DISTRICT 1
Other - Org Name:GRISELL MEMORIAL HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-731-2231
Mailing Address - Street 1:210 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:RANSOM
Mailing Address - State:KS
Mailing Address - Zip Code:67572-9525
Mailing Address - Country:US
Mailing Address - Phone:785-731-2231
Mailing Address - Fax:785-731-2895
Practice Address - Street 1:210 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:RANSOM
Practice Address - State:KS
Practice Address - Zip Code:67572-9525
Practice Address - Country:US
Practice Address - Phone:785-731-2231
Practice Address - Fax:785-731-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH068002208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016794OtherBLUE CROSS BLUE SHIELD
KS016794OtherBLUE CROSS BLUE SHIELD
KS100214190AMedicare ID - Type Unspecified