Healthcare Provider Details

I. General information

NPI: 1376548370
Provider Name (Legal Business Name): COFFEY COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 4TH
BURLINGTON KS
66839-2602
US

IV. Provider business mailing address

801 N 4TH ST
BURLINGTON KS
66839-2602
US

V. Phone/Fax

Practice location:
  • Phone: 620-364-2121
  • Fax: 620-364-4525
Mailing address:
  • Phone: 620-364-2121
  • Fax: 620-364-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MERRI MICHAELS
Title or Position: BILLING MANANGER
Credential:
Phone: 620-364-2121