=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083633374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM NEWTON MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 NORTH MAIN
-----------------------------------------------------
City | DEXTER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-876-5863
-----------------------------------------------------
Fax | 620-876-5865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 240 204 NORTH MAIN
-----------------------------------------------------
City | DEXTER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67038-0240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-876-5863
-----------------------------------------------------
Fax | 620-876-5865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC MANAGER
-----------------------------------------------------
Name | MRS. FAYE E MELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-758-2221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 173433
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------