Provider Demographics
NPI:1659464709
Name:COUNTY OF KIOWA HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:COUNTY OF KIOWA HOSPITAL DISTRICT
Other - Org Name:EADS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-438-5401
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:CO
Mailing Address - Zip Code:81036-0817
Mailing Address - Country:US
Mailing Address - Phone:719-438-2251
Mailing Address - Fax:719-438-2254
Practice Address - Street 1:1211 LUTHER ST
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:CO
Practice Address - Zip Code:81036
Practice Address - Country:US
Practice Address - Phone:719-438-2251
Practice Address - Fax:719-438-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06-8501Medicare ID - Type Unspecified