Healthcare Provider Details

I. General information

NPI: 1407123623
Provider Name (Legal Business Name): MUNSON ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

550 POPE AVE
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6143
  • Fax: 913-684-6208
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number28080967A
License Number StateIN

VIII. Authorized Official

Name: EDITH L COTTON
Title or Position: CREDENTIALS MANAGER
Credential:
Phone: 913-684-6143