Provider Demographics
NPI:1912195728
Name:MORTON COUNTY HOSPITAL
Entity Type:Organization
Organization Name:MORTON COUNTY HOSPITAL
Other - Org Name:KEYES MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-697-2141
Mailing Address - Street 1:300 S POLK
Mailing Address - Street 2:
Mailing Address - City:KEYES
Mailing Address - State:OK
Mailing Address - Zip Code:73947
Mailing Address - Country:US
Mailing Address - Phone:580-546-7062
Mailing Address - Fax:580-546-7063
Practice Address - Street 1:411 SUNSET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-0460
Practice Address - Country:US
Practice Address - Phone:620-697-2175
Practice Address - Fax:620-697-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100695030BMedicaid
OK900522010Medicare PIN