Healthcare Provider Details

I. General information

NPI: 1720390602
Provider Name (Legal Business Name): GOODLAND REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 2ND ST
GOODLAND KS
67735
US

IV. Provider business mailing address

220 W 2ND ST
GOODLAND KS
67735-1602
US

V. Phone/Fax

Practice location:
  • Phone: 785-890-3625
  • Fax: 785-890-6373
Mailing address:
  • Phone: 785-890-3625
  • Fax: 785-890-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberH-091-001
License Number StateKS

VIII. Authorized Official

Name: DIANA LYNN SLOUGH
Title or Position: INS/PT ACCOUNTS MANAGER
Credential:
Phone: 785-890-6012