MEDICARE: GOVE COUNTY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	H032001	KS
2	251E00000X	Home Health Agency		KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000674	OTHER	KS	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000674	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1588609747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOVE COUNTY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:	520 W 5TH STREET
City	:	QUINTER
State	:	KS
Zip	:	67752-0129
Country	:	US
Telephone Number	:	785-754-3341
Fax Number	:	785-754-3329

Provider Business Practice Location Address
First Line	:	520 W 5TH STREET
Second Line	:
City	:	QUINTER
State	:	KS
Zip	:	67752-0129
Country	:	US
Telephone Number	:	785-754-3341
Fax Number	:	785-754-3329

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICHARD Q BERGLING
Credential	:
Telephone Number	:	785-754-3341

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	06/25/2014

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Directions to “GOVE COUNTY MEDICAL CENTER ” Practice Location

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