Provider Demographics
NPI:1710985429
Name:LABETTE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:LABETTE COUNTY MEDICAL CENTER
Other - Org Name:LABETTE HEALTH ST. PAUL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACARONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-820-5251
Mailing Address - Street 1:200 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:KS
Mailing Address - Zip Code:66771-4044
Mailing Address - Country:US
Mailing Address - Phone:620-449-2582
Mailing Address - Fax:620-449-2587
Practice Address - Street 1:200 CARROLL ST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:KS
Practice Address - Zip Code:66771-4044
Practice Address - Country:US
Practice Address - Phone:620-449-2582
Practice Address - Fax:620-449-2587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABETTE COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS173432Medicare Oscar/Certification