Provider Demographics
NPI:1841387008
Name:MEDICALODGES, INC.
Entity Type:Organization
Organization Name:MEDICALODGES, INC.
Other - Org Name:MEDICALODGES WICHITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. OF FINANCIAL REPORTING
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-251-6700
Mailing Address - Street 1:2280 S MINNEAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-5318
Mailing Address - Country:US
Mailing Address - Phone:316-265-5693
Mailing Address - Fax:316-265-3700
Practice Address - Street 1:2280 S MINNEAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-5318
Practice Address - Country:US
Practice Address - Phone:316-265-5693
Practice Address - Fax:316-265-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087021314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107330AMedicaid
KS100107330AMedicaid
KS0411980010Medicare ID - Type Unspecified