=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275614059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TREGO COUNTY LEMKE MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 N 14TH ST
-----------------------------------------------------
City | WAKEENEY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67672-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-743-2124
-----------------------------------------------------
Fax | 785-743-2265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 N 13TH ST
-----------------------------------------------------
City | WAKEENEY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67672-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-743-2182
-----------------------------------------------------
Fax | 785-743-6317
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | CHRISTINE ADAMS-CLELAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-743-2182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC0050X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QC0050X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital Clinic/Center
-----------------------------------------------------
License Number | H-098-001
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------