Healthcare Provider Details

I. General information

NPI: 1902899339
Provider Name (Legal Business Name): WAMEGO HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 GENN DR
WAMEGO KS
66547
US

IV. Provider business mailing address

711 GENN DR
WAMEGO KS
66547-1179
US

V. Phone/Fax

Practice location:
  • Phone: 785-456-2295
  • Fax: 785-456-9467
Mailing address:
  • Phone: 785-456-2295
  • Fax: 785-456-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH-075-002
License Number StateKS

VIII. Authorized Official

Name: STEVE LAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-456-2295