Healthcare Provider Details

I. General information

NPI: 1447440318
Provider Name (Legal Business Name): MINNEOLA DISTRICT HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN ST
MINNEOLA KS
67865-0127
US

IV. Provider business mailing address

PO BOX 127
MINNEOLA KS
67865-0127
US

V. Phone/Fax

Practice location:
  • Phone: 620-885-4264
  • Fax: 620-885-4602
Mailing address:
  • Phone: 620-885-4264
  • Fax: 620-885-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberH013002
License Number StateKS

VIII. Authorized Official

Name: MR. BRIAN ROLAND
Title or Position: CEO
Credential:
Phone: 620-885-4264