Provider Demographics
NPI:1013009828
Name:MINNEOLA DISTRICT HOSPITAL NBR 2
Entity Type:Organization
Organization Name:MINNEOLA DISTRICT HOSPITAL NBR 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-885-4264
Mailing Address - Street 1:BOX 127
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:KS
Mailing Address - Zip Code:67865-0127
Mailing Address - Country:US
Mailing Address - Phone:620-885-4264
Mailing Address - Fax:620-885-4602
Practice Address - Street 1:212 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:KS
Practice Address - Zip Code:67865-8511
Practice Address - Country:US
Practice Address - Phone:620-885-4264
Practice Address - Fax:620-885-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH013002282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099190BMedicaid
014061OtherBLUE SHIELD (PC)
KS171368A000000OtherUNDOCUMENTED ALIENS
KS000185OtherBLUE CROSS BLUE SHIELD
KS100099190AMedicaid
KS000185OtherBLUE CROSS BLUE SHIELD
KS43-54098-061Medicare PIN
KS100099190AMedicaid
057127Medicare UPIN
KS556862Medicare PIN
014061OtherBLUE SHIELD (PC)
KSQ53253Medicare UPIN
R62846Medicare UPIN
KS54522Medicare PIN