Provider Demographics
NPI:1790790566
Name:SEDGWICK COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SEDGWICK COUNTY MEMORIAL HOSPITAL
Other - Org Name:BIG SPRINGS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-474-3323
Mailing Address - Street 1:900 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:JULESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80737-1121
Mailing Address - Country:US
Mailing Address - Phone:970-474-3323
Mailing Address - Fax:970-474-2758
Practice Address - Street 1:100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG SPRINGS
Practice Address - State:NE
Practice Address - Zip Code:69122-5048
Practice Address - Country:US
Practice Address - Phone:308-889-3376
Practice Address - Fax:308-889-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
283424Medicare ID - Type Unspecified