Provider Demographics
NPI:1881646735
Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Entity Type:Organization
Organization Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Other - Org Name:SATANTA DISTRICT HOSPITAL CLINIC-SUBLETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINGENPEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-649-2761
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:SUBLETTE
Mailing Address - State:KS
Mailing Address - Zip Code:67877-0398
Mailing Address - Country:US
Mailing Address - Phone:620-675-2686
Mailing Address - Fax:620-675-2236
Practice Address - Street 1:301 S. DERBY
Practice Address - Street 2:
Practice Address - City:SUBLETTE
Practice Address - State:KS
Practice Address - Zip Code:67877-0398
Practice Address - Country:US
Practice Address - Phone:620-675-2686
Practice Address - Fax:620-675-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363L00000X
KSH-041-001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100262260AMedicaid
KSOO1272OtherBLUE CROS PROVIDER #
KS173454Medicare Oscar/Certification