Healthcare Provider Details

I. General information

NPI: 1134163389
Provider Name (Legal Business Name): CLAY COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
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 802827
KANSAS CITY MO
64180-2827
US

V. Phone/Fax

Practice location:
  • Phone: 785-632-2144
  • Fax: 785-632-3352
Mailing address:
  • Phone: 785-632-2144
  • Fax: 785-632-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

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