MEDICARE: KANSAS MASONIC HOME, INC.

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	315D00000X	Inpatient Hospice	Z087011	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0578	OTHER	KS	BLUE CROSS-BLUE SHIELD

General Provider Information

NPI Number	:	1952516346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANSAS MASONIC HOME, INC.

Provider Business Mailing Address
First Line	:	401 S SENECA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-5541
Country	:	US
Telephone Number	:	316-269-7652
Fax Number	:	316-267-2199

Provider Business Practice Location Address
First Line	:	401 S SENECA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-5541
Country	:	US
Telephone Number	:	316-269-7652
Fax Number	:	316-267-2199

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	TIM C NIKKEL
Credential	:
Telephone Number	:	316-269-7652

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1437244654 — KANSAS MASONIC HOME
Practice Location Address:

401 S SENECA ST
WICHITA, KS
67213-5541

Practice Phone: 316-269-7652
Practice Fax: 316-269-7643

1841323573 — KANSAS MASONIC HOME, INC.
Practice Location Address:

401 S SENECA ST
WICHITA, KS
67213-5541

Practice Phone: 316-269-7500
Practice Fax: 316-267-2199

1003779810 — SARAH LUECK
Practice Location Address:

1319 W MAY ST
WICHITA, KS
67213-3505

Practice Phone: 316-364-8767
Practice Fax:

1699639047 — ZOE ELIZABETH BAKER CNA
Practice Location Address:

2244 S HIRAM ST
WICHITA, KS
67213-3140

Practice Phone: 316-618-6361
Practice Fax:

1437156023 — ADVANTAGE HOME CARE INCORPORATED
Practice Location Address:

1611 W HARRY ST
WICHITA, KS
67213-3653

Practice Phone: 316-262-4484
Practice Fax: 316-262-5270

1407848161 — GERALDINE MCFADDEN
Practice Location Address:

2301 S WATER ST
WICHITA, KS
67213-4819

Practice Phone: 316-682-4646
Practice Fax: 316-263-4116

Directions to “KANSAS MASONIC HOME, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.