Healthcare Provider Details

I. General information

NPI: 1285634006
Provider Name (Legal Business Name): FREDONIA REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 MADISON ST
FREDONIA KS
66736-1751
US

IV. Provider business mailing address

1527 MADISON
FREDONIA KS
66736-0579
US

V. Phone/Fax

Practice location:
  • Phone: 620-378-2121
  • Fax: 620-378-3169
Mailing address:
  • Phone: 620-378-2121
  • Fax: 620-378-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH103001
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRACY LYNN ROW
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 620-378-6204