Healthcare Provider Details

I. General information

NPI: 1922520832
Provider Name (Legal Business Name): SUSAN B. ALLEN MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W 7TH AVE
AUGUSTA KS
67010-1309
US

IV. Provider business mailing address

720 W CENTRAL AVE
EL DORADO KS
67042-2112
US

V. Phone/Fax

Practice location:
  • Phone: 316-558-8668
  • Fax: 316-558-5609
Mailing address:
  • Phone: 316-321-3300
  • Fax: 316-321-4810

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: MELISSA HALL
Title or Position: CEO
Credential:
Phone: 316-322-4558