Healthcare Provider Details

I. General information

NPI: 1790777324
Provider Name (Legal Business Name): HODGEMAN COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W BRAMLEY ST
JETMORE KS
67854-9320
US

IV. Provider business mailing address

PO BOX 310
JETMORE KS
67854-0310
US

V. Phone/Fax

Practice location:
  • Phone: 620-357-8354
  • Fax: 620-357-6460
Mailing address:
  • Phone: 620-357-8354
  • Fax: 620-357-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STACEY BRIGGS
Title or Position: CFO
Credential:
Phone: 620-357-8361