Healthcare Provider Details

I. General information

NPI: 1215937263
Provider Name (Legal Business Name): ELLSWORTH COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 AVENUE E
WILSON KS
67490
US

IV. Provider business mailing address

1602 AYLWARD AVE
ELLSWORTH KS
67439-2541
US

V. Phone/Fax

Practice location:
  • Phone: 785-658-3688
  • Fax: 785-658-3618
Mailing address:
  • Phone: 785-472-3111
  • Fax: 785-472-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES KIRKBRIDE
Title or Position: CEO
Credential:
Phone: 785-472-3111