Provider Demographics
NPI:1205918356
Name:COFFEY COUNTY HOSPITAL
Entity type:Organization
Organization Name:COFFEY COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-364-2121
Mailing Address - Street 1:309 SANDERS ST
Mailing Address - Street 2:P.O. BOX 289
Mailing Address - City:BURLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66839-2616
Mailing Address - Country:US
Mailing Address - Phone:620-364-5395
Mailing Address - Fax:620-364-8719
Practice Address - Street 1:538 N C STREET
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:KS
Practice Address - Zip Code:66857
Practice Address - Country:US
Practice Address - Phone:620-964-2264
Practice Address - Fax:620-964-2265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COFFEY COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-19
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS173984Medicare ID - Type Unspecified