Provider Demographics
NPI:1992044184
Name:MEDICALODGES, INC.
Entity Type:Organization
Organization Name:MEDICALODGES, INC.
Other - Org Name:MEDICALODGES FRONTENAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-709-0305
Mailing Address - Street 1:206 S DITTMAN ST
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:KS
Mailing Address - Zip Code:66763-2253
Mailing Address - Country:US
Mailing Address - Phone:620-231-7340
Mailing Address - Fax:620-231-3955
Practice Address - Street 1:206 S DITTMAN ST
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:KS
Practice Address - Zip Code:66763-2253
Practice Address - Country:US
Practice Address - Phone:620-231-7340
Practice Address - Fax:620-231-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN019007314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107330LMedicaid
KS100107330LMedicaid