Provider Demographics
NPI:1932314762
Name:MORTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:MORTON COUNTY HOSPITAL
Other - Org Name:MORTON COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-697-5200
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:411 SUNSET
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950
Mailing Address - Country:US
Mailing Address - Phone:620-697-2175
Mailing Address - Fax:620-697-2185
Practice Address - Street 1:411 SUNSET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950
Practice Address - Country:US
Practice Address - Phone:620-697-2175
Practice Address - Fax:620-697-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS170166Medicare Oscar/Certification