Healthcare Provider Details

I. General information

NPI: 1467565705
Provider Name (Legal Business Name): FREDONIA REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date: 08/14/2007
Reactivation Date: 10/31/2013

III. Provider practice location address

1527 MADISON ST
FREDONIA KS
66736-1751
US

IV. Provider business mailing address

1527 MADISON ST
FREDONIA KS
66736-1751
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 Code341600000X
TaxonomyAmbulance
License Number640
License Number StateKS

VIII. Authorized Official

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