Provider Demographics
NPI:1629039219
Name:HOSPITAL DISTRICT 5 OF HARPER COUNTY, KANSAS
Entity Type:Organization
Organization Name:HOSPITAL DISTRICT 5 OF HARPER COUNTY, KANSAS
Other - Org Name:HARPER HOSPITAL MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-896-7324
Mailing Address - Street 1:700 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:KS
Mailing Address - Zip Code:67058-1401
Mailing Address - Country:US
Mailing Address - Phone:620-896-7324
Mailing Address - Fax:620-896-7127
Practice Address - Street 1:700 W 13TH ST
Practice Address - Street 2:
Practice Address - City:HARPER
Practice Address - State:KS
Practice Address - Zip Code:67058-1480
Practice Address - Country:US
Practice Address - Phone:620-896-7306
Practice Address - Fax:620-896-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH039003261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098960DMedicaid
KS100098960DMedicaid
KS173407Medicare Oscar/Certification