Healthcare Provider Details

I. General information

NPI: 1609836899
Provider Name (Legal Business Name): MEDICALODGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W 1ST ST
COFFEYVILLE KS
67337-3854
US

IV. Provider business mailing address

720 W 1ST ST
COFFEYVILLE KS
67337-3854
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-3705
  • Fax: 620-251-2410
Mailing address:
  • Phone: 620-251-3705
  • Fax: 620-251-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN063006
License Number StateKS

VIII. Authorized Official

Name: MS. CATHY W FISHER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 620-251-6700