Provider Demographics
NPI:1700994977
Name:SUSAN B. ALLEN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SUSAN B. ALLEN MEMORIAL HOSPITAL
Other - Org Name:SUSAN B. ALLEN MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-322-4558
Mailing Address - Street 1:720 W. CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2144
Mailing Address - Country:US
Mailing Address - Phone:316-321-3300
Mailing Address - Fax:316-321-2916
Practice Address - Street 1:720 W. CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2144
Practice Address - Country:US
Practice Address - Phone:316-321-3300
Practice Address - Fax:316-321-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X, 3336C0003X, 3336I0012X
KS2-08568333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160905OtherPK
1700994977Medicare Oscar/Certification
KS633400OtherFIRST GUARD
KS000046OtherBLUE CROSS BLUE SHIELD
KS465045OtherFAMILY HEALTH PARTNERS
KS1356783286Medicare Oscar/Certification
CAXHSP33931Medicaid
KS170017Medicare Oscar/Certification
KS1922431329Medicare Oscar/Certification
CAXHSP43931Medicaid
KS1356783286Medicare Oscar/Certification