Provider Demographics
NPI:1841298411
Name:LABETTE COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:LABETTE COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACARONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-820-5251
Mailing Address - Street 1:1902 S US HIGHWAY 59
Mailing Address - Street 2:BLDG D, STE 4
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-4948
Mailing Address - Country:US
Mailing Address - Phone:620-421-2733
Mailing Address - Fax:620-820-5574
Practice Address - Street 1:1902 S US HIGHWAY 59
Practice Address - Street 2:BLDG D, STE 4
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4948
Practice Address - Country:US
Practice Address - Phone:620-421-2733
Practice Address - Fax:620-820-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCK3451Medicare PIN
KS110846Medicare PIN