=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801437496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM NEWTON MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2019
-----------------------------------------------------
Last Update Date | 10/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 E 6TH AVE STE 2A
-----------------------------------------------------
City | WINFIELD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67156-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-221-4443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 E 6TH AVE STE 2A
-----------------------------------------------------
City | WINFIELD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67156-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-221-4443
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | BRIAN BARTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-222-6204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------