Healthcare Provider Details

I. General information

NPI: 1841245396
Provider Name (Legal Business Name): CLAY COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 LIBERTY ST
CLAY CENTER KS
67432-1564
US

IV. Provider business mailing address

PO BOX 512
CLAY CENTER KS
67432-0512
US

V. Phone/Fax

Practice location:
  • Phone: 785-632-2144
  • Fax: 785-632-3352
Mailing address:
  • Phone: 785-632-2144
  • Fax: 785-632-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH014001
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH014001
License Number StateKS

VIII. Authorized Official

Name: AUSTIN GILLARD
Title or Position: CEO
Credential:
Phone: 785-632-2144