Healthcare Provider Details

I. General information

NPI: 1801823687
Provider Name (Legal Business Name): SCOTT COUNTY HOSPITAL DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 3RD ST
SCOTT CITY KS
67871
US

IV. Provider business mailing address

310 E 3RD ST
SCOTT CITY KS
67871
US

V. Phone/Fax

Practice location:
  • Phone: 620-872-5811
  • Fax: 620-872-7193
Mailing address:
  • Phone: 620-872-5811
  • Fax: 620-872-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier10091670G
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier048631
Identifier TypeOTHER
Identifier StateKS
Identifier IssuerBCBS

VIII. Authorized Official

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