Healthcare Provider Details

I. General information

NPI: 1366700593
Provider Name (Legal Business Name): THE CLARA BARTON HOSPITAL ASSOCIATION INC HOISINGTON KANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 JACKSON ST
GREAT BEND KS
67530-4219
US

IV. Provider business mailing address

250 W 9TH ST
HOISINGTON KS
67544-1706
US

V. Phone/Fax

Practice location:
  • Phone: 620-793-6990
  • Fax:
Mailing address:
  • Phone: 620-653-2114
  • Fax: 620-653-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH-005-003
License Number StateKS

VIII. Authorized Official

Name: MR. JAMES G BLACKWELL
Title or Position: PRESIDENT & CEO
Credential:
Phone: 620-653-2114