Healthcare Provider Details

I. General information

NPI: 1144770298
Provider Name (Legal Business Name): LINDSBORG COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 10TH ST
GREAT BEND KS
67530-3542
US

IV. Provider business mailing address

605 W LINCOLN ST
LINDSBORG KS
67456-2328
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-7868
  • Fax:
Mailing address:
  • Phone: 785-227-3308
  • Fax: 785-227-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH-059-001
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-059-001
License Number StateKS

VIII. Authorized Official

Name: LARRY VAN DER WEGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-227-3308