Healthcare Provider Details

I. General information

NPI: 1619913613
Provider Name (Legal Business Name): PHILLIPS COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W MAIN ST
LOGAN KS
67646-9764
US

IV. Provider business mailing address

214 W MAIN ST P.O. BOX 173
LOGAN KS
67646-9764
US

V. Phone/Fax

Practice location:
  • Phone: 785-689-4220
  • Fax: 785-689-4219
Mailing address:
  • Phone: 785-689-4220
  • Fax: 785-689-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number44437
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0433764
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHONDA L KELLERMAN
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 785-543-5211