Healthcare Provider Details

I. General information

NPI: 1700975729
Provider Name (Legal Business Name): MINNEOLA DISTRICT HOSPITAL NBR 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 MAIN STREET
FOWLER KS
67844-0462
US

IV. Provider business mailing address

PO BOX 462
FOWLER KS
67844-0462
US

V. Phone/Fax

Practice location:
  • Phone: 620-646-5446
  • Fax: 620-646-5708
Mailing address:
  • Phone: 620-646-5446
  • Fax: 620-646-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH013002
License Number StateKS

VIII. Authorized Official

Name: DEBORAH BRUNER
Title or Position: CEO
Credential:
Phone: 620-885-4264