Provider Demographics
NPI:1699850958
Name:COFFEY COUNTY HOSPITAL
Entity Type:Organization
Organization Name:COFFEY COUNTY HOSPITAL
Other - Org Name:COFFEY COUNTY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-364-2121
Mailing Address - Street 1:801 N. 4TH
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66839-2602
Mailing Address - Country:US
Mailing Address - Phone:620-364-2121
Mailing Address - Fax:620-364-8425
Practice Address - Street 1:801 N. 4TH
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839-2602
Practice Address - Country:US
Practice Address - Phone:620-364-2121
Practice Address - Fax:620-364-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100247830AMedicaid
KS180038OtherBLUE CROSS & BLUE SHIELD
KS180038OtherBLUE CROSS & BLUE SHIELD
170094Medicare UPIN