Provider Demographics
NPI:1194723890
Name:LABETTE COUNTY MEDICAL CENTER
Entity type:Organization
Organization Name:LABETTE COUNTY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACARONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-820-5251
Mailing Address - Street 1:1902 S HWY 59 BLDG E
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357
Mailing Address - Country:US
Mailing Address - Phone:620-820-5889
Mailing Address - Fax:620-820-5821
Practice Address - Street 1:324 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:KS
Practice Address - Zip Code:66733-1439
Practice Address - Country:US
Practice Address - Phone:620-244-3291
Practice Address - Fax:620-244-5458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LABETTE COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016753Medicare PIN
KSCC6708Medicare PIN