Healthcare Provider Details

I. General information

NPI: 1447280078
Provider Name (Legal Business Name): SCOTT COUNTY HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 4TH ST
SCOTT CITY KS
67871-1254
US

IV. Provider business mailing address

110 E. 4TH STR.
SCOTT CITY KS
67871
US

V. Phone/Fax

Practice location:
  • Phone: 620-874-4868
  • Fax: 620-872-5014
Mailing address:
  • Phone: 620-874-4868
  • Fax: 620-872-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000557
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBCBS HH #
# 2
Identifier000557
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBCBS
# 3
Identifier000557
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBCBS OF KS
# 4
Identifier100091670D
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name: MR. D MARK BURNETT
Title or Position: CEO
Credential:
Phone: 620-872-5811