Provider Demographics
NPI:1700824398
Name:MIAMI COUNTY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:MIAMI COUNTY MEDICAL CENTER INC
Other - Org Name:MIAMI COUNTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIERNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-791-4461
Mailing Address - Street 1:2100 BAPTISTE DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1314
Mailing Address - Country:US
Mailing Address - Phone:913-294-2327
Mailing Address - Fax:913-294-9897
Practice Address - Street 1:2100 BAPTISTE DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1314
Practice Address - Country:US
Practice Address - Phone:913-294-2327
Practice Address - Fax:913-294-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH061001282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099280AMedicaid
KS170109Medicare Oscar/Certification