Provider Demographics
NPI:1689601007
Name:MORTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:MORTON COUNTY HOSPITAL
Other - Org Name:MORTON COUNTY HOSPITAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-697-2141
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0937
Mailing Address - Country:US
Mailing Address - Phone:620-697-2141
Mailing Address - Fax:620-697-4766
Practice Address - Street 1:445 HILLTOP STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950
Practice Address - Country:US
Practice Address - Phone:620-697-2141
Practice Address - Fax:620-697-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH065001207P00000X, 2085R0202X, 363AM0700X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100087540BMedicaid
KS000190OtherBCBS
KS014050Medicare ID - Type Unspecified