Provider Demographics
NPI:1215122429
Name:EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Entity type:Organization
Organization Name:EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRICKBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-659-3621
Mailing Address - Street 1:620 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KINSLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67547-2329
Mailing Address - Country:US
Mailing Address - Phone:620-659-3621
Mailing Address - Fax:620-659-3869
Practice Address - Street 1:620 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:KINSLEY
Practice Address - State:KS
Practice Address - Zip Code:67547-2348
Practice Address - Country:US
Practice Address - Phone:620-659-3621
Practice Address - Fax:620-659-3869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARDS COUNTY HOSPITAL AND HEALTHCARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QC0050X261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100103110AMedicaid
KS100103110AMedicaid
016623Medicare Oscar/Certification