Healthcare Provider Details

I. General information

NPI: 1093747693
Provider Name (Legal Business Name): BUCKLIN DISTRICT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W. ELM
BUCKLIN KS
67834-0248
US

IV. Provider business mailing address

PO BOX 248
BUCKLIN KS
67834-0248
US

V. Phone/Fax

Practice location:
  • Phone: 620-826-3202
  • Fax: 620-826-3591
Mailing address:
  • Phone: 620-826-3202
  • Fax: 620-826-3591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN029004
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN029004
License Number StateKS

VIII. Authorized Official

Name: MRS. JUDITH KAY KREGAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 620-826-3202