Healthcare Provider Details

I. General information

NPI: 1326098914
Provider Name (Legal Business Name): ST. JOSEPH MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 W 11TH ST
LARNED KS
67550-2055
US

IV. Provider business mailing address

PO BOX 970
GREAT BEND KS
67530-0970
US

V. Phone/Fax

Practice location:
  • Phone: 620-285-6958
  • Fax: 620-285-2173
Mailing address:
  • Phone: 620-786-6475
  • Fax: 620-786-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON L. LIND
Title or Position: CEO
Credential:
Phone: 620-786-6101