Provider Demographics
NPI:1720390602
Name:GOODLAND REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:GOODLAND REGIONAL MEDICAL CENTER
Other - Org Name:HIGH PLAINS REGIONAL DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INS/PT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-890-6012
Mailing Address - Street 1:220 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-1602
Mailing Address - Country:US
Mailing Address - Phone:785-890-3625
Mailing Address - Fax:785-890-6373
Practice Address - Street 1:220 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735
Practice Address - Country:US
Practice Address - Phone:785-890-3625
Practice Address - Fax:785-890-6373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOODLAND REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-08
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-091-001261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS172308Medicare Oscar/Certification