Healthcare Provider Details

I. General information

NPI: 1730277690
Provider Name (Legal Business Name): MEDICALODGES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WINCHESTER AVE
KINSLEY KS
67547-2348
US

IV. Provider business mailing address

620 WINCHESTER AVE
KINSLEY KS
67547-2348
US

V. Phone/Fax

Practice location:
  • Phone: 620-659-2156
  • Fax: 620-659-2043
Mailing address:
  • Phone: 620-659-2156
  • Fax: 620-659-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN024001
License Number StateKS

VIII. Authorized Official

Name: MR. SCOTT L HINES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 620-709-0305