=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689605263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFERSON COUNTY MEMORIAL HOSPITAL FOUNDATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 10/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 DELAWARE STREET
-----------------------------------------------------
City | OSKALOOSA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-863-3401
-----------------------------------------------------
Fax | 785-863-3405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 DELAWARE STREET
-----------------------------------------------------
City | OSKALOOSA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-863-3401
-----------------------------------------------------
Fax | 785-863-3405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OF BOARD OF DIRECTORS
-----------------------------------------------------
Name | MS. TAMARA GIGSTAD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-774-4340
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 209658
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------