Healthcare Provider Details

I. General information

NPI: 1710065180
Provider Name (Legal Business Name): MEDICALODGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LEE AVE
COLUMBUS KS
66725-1021
US

IV. Provider business mailing address

101 LEE AVE
COLUMBUS KS
66725-1021
US

V. Phone/Fax

Practice location:
  • Phone: 620-429-2134
  • Fax: 620-429-8956
Mailing address:
  • Phone: 620-429-2134
  • Fax: 620-429-8956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberN011003
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberN011003
License Number StateKS

VIII. Authorized Official

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