Healthcare Provider Details

I. General information

NPI: 1750354908
Provider Name (Legal Business Name): JEFFERSON COUNTY MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
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: 913-774-4340
  • Fax: 913-774-3379
Mailing address:
  • Phone: 913-774-4340
  • Fax: 913-774-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LAMONT COOK
Title or Position: CEO
Credential:
Phone: 913-774-4340