Healthcare Provider Details

I. General information

NPI: 1639699309
Provider Name (Legal Business Name): WILSON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OTTAWA RD STE 101
NEODESHA KS
66757-1897
US

IV. Provider business mailing address

PO BOX 360
NEODESHA KS
66757-0360
US

V. Phone/Fax

Practice location:
  • Phone: 620-325-2622
  • Fax: 620-325-5380
Mailing address:
  • Phone: 620-325-2611
  • Fax: 620-325-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH103002
License Number StateKS

VIII. Authorized Official

Name: LORI C SMITH
Title or Position: CFO
Credential:
Phone: 620-325-8388