Provider Demographics
NPI:1659302131
Name:SCOTT COUNTY HOSPITAL
Entity Type:Organization
Organization Name:SCOTT COUNTY HOSPITAL
Other - Org Name:SCOTT COUNTY HOSPITAL AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-872-5811
Mailing Address - Street 1:201 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871-6117
Mailing Address - Country:US
Mailing Address - Phone:620-872-5811
Mailing Address - Fax:620-872-3660
Practice Address - Street 1:201 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871-6117
Practice Address - Country:US
Practice Address - Phone:620-872-5811
Practice Address - Fax:620-872-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTT COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS112022OtherBCBS OF KS
KS112022OtherBC
KS100091670IMedicaid