Healthcare Provider Details

I. General information

NPI: 1235167750
Provider Name (Legal Business Name): JEFFERSON COUNTY MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 DELAWARE ST
WINCHESTER KS
66097-4003
US

IV. Provider business mailing address

408 DELAWARE ST
WINCHESTER KS
66097-4003
US

V. Phone/Fax

Practice location:
  • Phone: 913-933-4020
  • Fax: 844-415-1702
Mailing address:
  • Phone: 913-933-4020
  • Fax: 844-415-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberHO44001
License Number StateKS

VIII. Authorized Official

Name: MR. LAMONT M COOK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 913-933-4020