Provider Demographics
NPI:1619261211
Name:NEOSHO MEMORIAL REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:NEOSHO MEMORIAL REGIONAL MEDICAL CENTER
Other - Org Name:NMRMC ORTHOPEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-431-4000
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0426
Mailing Address - Country:US
Mailing Address - Phone:620-431-4000
Mailing Address - Fax:620-431-7556
Practice Address - Street 1:1500 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2575
Practice Address - Country:US
Practice Address - Phone:620-432-5775
Practice Address - Fax:620-431-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-067-001207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS014064Medicare Oscar/Certification