Healthcare Provider Details

I. General information

NPI: 1992733539
Provider Name (Legal Business Name): HOSPITAL DISTRICT NO 1 CRAWFORD COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N HIGHWAY 69
FRONTENAC KS
66763-8100
US

IV. Provider business mailing address

1011 N HIGHWAY 69
FRONTENAC KS
66763-8100
US

V. Phone/Fax

Practice location:
  • Phone: 620-235-1377
  • Fax: 620-235-1558
Mailing address:
  • Phone: 620-235-1377
  • Fax: 620-235-1558

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 NumberH-019-001
License Number StateKS

VIII. Authorized Official

Name: HOLLY KOCH
Title or Position: CFO
Credential:
Phone: 620-724-8291