Healthcare Provider Details

I. General information

NPI: 1831237528
Provider Name (Legal Business Name): FORT HAYS STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PARK ST
HAYS KS
67601-4009
US

IV. Provider business mailing address

600 PARK ST LL045MU
HAYS KS
67601-4009
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-4293
  • Fax:
Mailing address:
  • Phone: 785-628-4678
  • Fax: 785-628-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-16850
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number44467
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL W. BARNETT
Title or Position: VP FOR ADMINISTRATION AND FINANCE
Credential:
Phone: 785-628-4251