=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932834009
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2022
-----------------------------------------------------
Last Update Date | 08/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 609 E 1ST AVE
-----------------------------------------------------
City | ST JOHN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67576-2223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-659-3802
-----------------------------------------------------
Fax | 620-659-3869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 99
-----------------------------------------------------
City | KINSLEY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67547-0099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-659-3802
-----------------------------------------------------
Fax | 620-659-3869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | JASON RYAN MURRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-659-3802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------