Provider Demographics
NPI:1841525276
Name:STANTON COUNTY HOSPITAL
Entity type:Organization
Organization Name:STANTON COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:TUSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-492-6250
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:KS
Mailing Address - Zip Code:67855-0639
Mailing Address - Country:US
Mailing Address - Phone:620-492-1400
Mailing Address - Fax:620-492-1608
Practice Address - Street 1:410 WEST COLORADO
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:CO
Practice Address - Zip Code:81047-0219
Practice Address - Country:US
Practice Address - Phone:719-537-6042
Practice Address - Fax:719-537-6052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STANTON COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicare Oscar/Certification
CO068511Medicare Oscar/Certification