Provider Demographics
| NPI: | 1619952785 |
|---|---|
| Name: | SALINA REGIONAL HEALTH CENTER, INC |
| Entity Type: | Organization |
| Organization Name: | SALINA REGIONAL HEALTH CENTER, INC |
| Other - Org Name: | PHYSICIAN PRACTICE MANAGEMENT |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | AMY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WIKOFF |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 785-452-6152 |
| Mailing Address - Street 1: | 400 S SANTA FE AVE |
| Mailing Address - Street 2: | SRHC REVENUE CYCLE MGMT |
| Mailing Address - City: | SALINA |
| Mailing Address - State: | KS |
| Mailing Address - Zip Code: | 67401-4144 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 785-452-7269 |
| Mailing Address - Fax: | 785-452-6008 |
| Practice Address - Street 1: | 501 S SANTA FE AVE |
| Practice Address - Street 2: | SUITE 200 |
| Practice Address - City: | SALINA |
| Practice Address - State: | KS |
| Practice Address - Zip Code: | 67401-4189 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 785-452-7269 |
| Practice Address - Fax: | 785-452-6008 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | SALINA REGIONAL HEALTH CENTER, INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2005-12-13 |
| Last Update Date: | 2019-01-16 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| KS | 103T00000X, 207RC0200X, 207RH0003X, 207RP1001X, 207T00000X, 207V00000X, 207X00000X, 2084N0400X, 2084P0800X, 208600000X, 208G00000X, 208M00000X, 213E00000X | |
| 208100000X, 332900000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
| No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KS | 100105940C | Medicaid | |
| KS | 110116 | Medicare PIN |
