Healthcare Provider Details

I. General information

NPI: 1700994977
Provider Name (Legal Business Name): SUSAN B. ALLEN MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W. CENTRAL AVE
EL DORADO KS
67042-2144
US

IV. Provider business mailing address

720 W. CENTRAL AVE
EL DORADO KS
67042-2144
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-3300
  • Fax: 316-321-2916
Mailing address:
  • Phone: 316-321-3300
  • Fax: 316-321-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2-08568
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MELISSA HALL
Title or Position: CEO
Credential:
Phone: 316-322-4558