Healthcare Provider Details

I. General information

NPI: 1689605263
Provider Name (Legal Business Name): JEFFERSON COUNTY MEMORIAL HOSPITAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 DELAWARE STREET
OSKALOOSA KS
66066
US

IV. Provider business mailing address

509 DELAWARE STREET
OSKALOOSA KS
66066
US

V. Phone/Fax

Practice location:
  • Phone: 785-863-3401
  • Fax: 785-863-3405
Mailing address:
  • Phone: 785-863-3401
  • Fax: 785-863-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number209658
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMARA GIGSTAD
Title or Position: PRESIDENT OF BOARD OF DIRECTORS
Credential:
Phone: 913-774-4340