Provider Demographics
NPI:1962489211
Name:MARION COUNTY RURAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:MARION COUNTY RURAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:W
Authorized Official - Last Name:HODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-382-3722
Mailing Address - Street 1:537 S FREEBORN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KS
Mailing Address - Zip Code:66861-1256
Mailing Address - Country:US
Mailing Address - Phone:620-382-3722
Mailing Address - Fax:620-382-3851
Practice Address - Street 1:537 S FREEBORN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KS
Practice Address - Zip Code:66861-1256
Practice Address - Country:US
Practice Address - Phone:620-382-3722
Practice Address - Fax:620-382-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
173888Medicare ID - Type Unspecified