Provider Demographics
NPI:1912009382
Name:EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Entity Type:Organization
Organization Name:EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Other - Org Name:EDWARDS COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-659-3621
Mailing Address - Street 1:620 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-2329
Mailing Address - Country:US
Mailing Address - Phone:620-659-3621
Mailing Address - Fax:620-659-3810
Practice Address - Street 1:620 W 8TH ST
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-2329
Practice Address - Country:US
Practice Address - Phone:620-659-3621
Practice Address - Fax:620-659-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSHP024001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100103110AMedicaid
KS17Z317Medicare Oscar/Certification