Provider Demographics
NPI:1669441176
Name:WILSON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:WILSON COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-325-2611
Mailing Address - Street 1:2600 OTTAWA RD
Mailing Address - Street 2:P O BOX 360
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1897
Mailing Address - Country:US
Mailing Address - Phone:620-325-2611
Mailing Address - Fax:620-325-8453
Practice Address - Street 1:2600 OTTAWA RD
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1897
Practice Address - Country:US
Practice Address - Phone:620-325-2611
Practice Address - Fax:620-325-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH103002282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099210AMedicaid
KS100099210AMedicaid