Healthcare Provider Details

I. General information

NPI: 1619000957
Provider Name (Legal Business Name): DECATUR HEALTH SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W COLUMBIA ST
OBERLIN KS
67749-2450
US

IV. Provider business mailing address

PO BOX 268
OBERLIN KS
67749-0268
US

V. Phone/Fax

Practice location:
  • Phone: 785-475-2208
  • Fax: 785-475-2453
Mailing address:
  • Phone: 785-475-2208
  • Fax: 785-475-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number54112
License Number StateKS

VIII. Authorized Official

Name: MR. KYLE TEEL
Title or Position: INTERIM CEO & INTERM COO
Credential:
Phone: 785-475-2208