Healthcare Provider Details

I. General information

NPI: 1710995147
Provider Name (Legal Business Name): MEDICALODGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 BEDFORD ST
GARDNER KS
66030-1185
US

IV. Provider business mailing address

223 BEDFORD ST
GARDNER KS
66030-1185
US

V. Phone/Fax

Practice location:
  • Phone: 913-856-6520
  • Fax: 913-856-5147
Mailing address:
  • Phone: 913-856-6520
  • Fax: 913-856-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT L HINES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 620-709-0305