Healthcare Provider Details

I. General information

NPI: 1437152766
Provider Name (Legal Business Name): KIOWA DISTRICT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S 4TH ST
KIOWA KS
67070-1825
US

IV. Provider business mailing address

1002 S 4TH ST
KIOWA KS
67070-1825
US

V. Phone/Fax

Practice location:
  • Phone: 620-825-4131
  • Fax: 620-825-4667
Mailing address:
  • Phone: 620-825-4131
  • Fax: 620-825-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-004-001
License Number StateKS

VIII. Authorized Official

Name: JANELL LYN GOODNO
Title or Position: CFO
Credential:
Phone: 620-825-4131