MEDICARE: MITCHELL COUNTY HOSPITAL HEALTH SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336I0012X	Institutional Pharmacy
2	3336L0003X	Long Term Care Pharmacy	2-08585	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2031502	OTHER		PK

General Provider Information

NPI Number	:	1396883054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL COUNTY HOSPITAL HEALTH SYSTEMS

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	BELOIT
State	:	KS
Zip	:	67420-0399
Country	:	US
Telephone Number	:	785-738-9480
Fax Number	:	785-738-9486

Provider Business Practice Location Address
First Line	:	400 W 8TH ST
Second Line	:
City	:	BELOIT
State	:	KS
Zip	:	67420-1605
Country	:	US
Telephone Number	:	785-738-9480
Fax Number	:	785-738-9486

Authorized Official
Title or Position	:	CFO
Name	:	ELDON KOEPKE
Credential	:	PHARMACIST
Telephone Number	:	785-738-2266

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	06/22/2015

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