=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063723617
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPITAL DISTRICT NO. 1 OF DICKINSON COUNTY, KANSAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2010
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 NE 10TH ST
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67410-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-263-4131
-----------------------------------------------------
Fax | 785-263-1634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 NE 10TH ST
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67410-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-263-4131
-----------------------------------------------------
Fax | 785-263-1634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KIMBERLY A HAVERLY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-263-6610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 021-01
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------