Provider Demographics
NPI:1710970140
Name:WAMEGO HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:WAMEGO HOSPITAL ASSOCIATION
Other - Org Name:WAMEGO HEALTH CENTER AND WAMEGO FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-456-2295
Mailing Address - Street 1:8200 THORN DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2709
Mailing Address - Country:US
Mailing Address - Phone:316-268-5178
Mailing Address - Fax:
Practice Address - Street 1:711 GENN DR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547
Practice Address - Country:US
Practice Address - Phone:785-456-2295
Practice Address - Fax:785-456-9467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-075-002275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001127OtherBLUE CROSS SWING #
KS17Z337Medicare Oscar/Certification