Provider Demographics
NPI:1801824123
Name:BOB WILSON MEMORIAL GRANT COUNTY HOSPITAL
Entity Type:Organization
Organization Name:BOB WILSON MEMORIAL GRANT COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:H
Authorized Official - Last Name:FRABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-356-6048
Mailing Address - Street 1:415 N MAIN
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880
Mailing Address - Country:US
Mailing Address - Phone:620-356-1266
Mailing Address - Fax:620-356-6014
Practice Address - Street 1:415 N MAIN
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880
Practice Address - Country:US
Practice Address - Phone:620-356-1266
Practice Address - Fax:620-356-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSHO34001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099420BMedicaid
KS10099420AMedicaid
KS001649OtherBLUE CROSS BLUE SHEILD
KS001649OtherBLUE CROSS BLUE SHEILD