Provider Demographics
NPI:1952485161
Name:HIAWATHA HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:HIAWATHA HOSPITAL ASSOCIATION INC
Other - Org Name:AMBERWELL HIAWATHA ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-742-6283
Mailing Address - Street 1:300 UTAH ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2314
Mailing Address - Country:US
Mailing Address - Phone:785-742-2131
Mailing Address - Fax:785-742-6588
Practice Address - Street 1:300 UTAH ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2314
Practice Address - Country:US
Practice Address - Phone:785-742-2131
Practice Address - Fax:785-742-6588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIAWATHA HOSPITAL ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-24
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
KSH007001282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012233Medicare ID - Type UnspecifiedPROVIDER NUMBER