Healthcare Provider Details

I. General information

NPI: 1730185174
Provider Name (Legal Business Name): EMPORIA SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 W 15TH AVE
EMPORIA KS
66801-0984
US

IV. Provider business mailing address

1602 W 15TH AVE
EMPORIA KS
66801-0984
US

V. Phone/Fax

Practice location:
  • Phone: 620-342-8822
  • Fax: 620-342-8832
Mailing address:
  • Phone: 620-342-8822
  • Fax: 620-342-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH056002
License Number StateKS

VIII. Authorized Official

Name: JOSEPH CONROY
Title or Position: ADMINISTRATOR
Credential:
Phone: 620-342-8822