Healthcare Provider Details

I. General information

NPI: 1265695993
Provider Name (Legal Business Name): KIOWA COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 LUTHER STREET
EADS CO
81036
US

IV. Provider business mailing address

1211 LUTHER STREET PO BOX 7
EADS CO
81036
US

V. Phone/Fax

Practice location:
  • Phone: 719-438-2251
  • Fax: 719-438-2254
Mailing address:
  • Phone: 719-438-2251
  • Fax: 719-438-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WARREN YULE
Title or Position: ADMINISTRATOR
Credential:
Phone: 719-438-2251