Healthcare Provider Details

I. General information

NPI: 1063562379
Provider Name (Legal Business Name): GOODLAND REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 2ND ST
GOODLAND KS
67735-1602
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:
Mailing address:
  • Phone: 785-890-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

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