Healthcare Provider Details

I. General information

NPI: 1760407407
Provider Name (Legal Business Name): WILSON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OTTAWA RD
NEODESHA KS
66757-1897
US

IV. Provider business mailing address

2600 OTTAWA RD P O BOX 360
NEODESHA KS
66757-1897
US

V. Phone/Fax

Practice location:
  • Phone: 620-325-2611
  • Fax: 620-325-8453
Mailing address:
  • Phone: 620-325-2611
  • Fax: 620-325-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH103002
License Number StateKS

VIII. Authorized Official

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