Provider Demographics
NPI:1295268928
Name:MORTON COUNTY HOSPITAL
Entity type:Organization
Organization Name:MORTON COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-697-2175
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0098
Mailing Address - Country:US
Mailing Address - Phone:620-593-4242
Mailing Address - Fax:620-593-4243
Practice Address - Street 1:415 WASHINGTON
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:KS
Practice Address - Zip Code:67954-0098
Practice Address - Country:US
Practice Address - Phone:620-593-4242
Practice Address - Fax:620-593-4243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORTON COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501277363A00000X
KS5377163363L00000X
KS0426359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178602Medicare UPIN