Provider Demographics
NPI:1588827216
Name:KIOWA COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:KIOWA COUNTY HOSPITAL DISTRICT
Other - Org Name:WILEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:YULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-438-2251
Mailing Address - Street 1:302 MAIN
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:WILEY
Mailing Address - State:CO
Mailing Address - Zip Code:81092
Mailing Address - Country:US
Mailing Address - Phone:719-829-4627
Mailing Address - Fax:719-829-4269
Practice Address - Street 1:302 MAIN
Practice Address - Street 2:
Practice Address - City:WILEY
Practice Address - State:CO
Practice Address - Zip Code:81092
Practice Address - Country:US
Practice Address - Phone:719-829-4627
Practice Address - Fax:719-829-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE2908Medicare PIN