Provider Demographics
NPI:1013921451
Name:KIOWA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:KIOWA COUNTY MEMORIAL HOSPITAL
Other - Org Name:HAVILAND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLCLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6207-233-3411
Mailing Address - Street 1:106 N MAIN ST
Mailing Address - Street 2:PO BOX 352
Mailing Address - City:HAVILAND
Mailing Address - State:KS
Mailing Address - Zip Code:67059-9500
Mailing Address - Country:US
Mailing Address - Phone:620-862-5431
Mailing Address - Fax:620-862-5441
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVILAND
Practice Address - State:KS
Practice Address - Zip Code:67059-9500
Practice Address - Country:US
Practice Address - Phone:620-862-5431
Practice Address - Fax:620-862-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110749Medicare ID - Type UnspecifiedPART B
KS173494Medicare Oscar/Certification