Provider Demographics
NPI:1821135815
Name:ST JOSEPH MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:ST JOSEPH MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-786-6101
Mailing Address - Street 1:923 CARROLL AVE
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2429
Mailing Address - Country:US
Mailing Address - Phone:620-285-3161
Mailing Address - Fax:620-285-8883
Practice Address - Street 1:923 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2429
Practice Address - Country:US
Practice Address - Phone:620-285-3161
Practice Address - Fax:620-285-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100112110BMedicaid