Provider Demographics
NPI:1215459367
Name:JEFFERSON COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:JEFFERSON COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HIM DIRECTOR/CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-536-9449
Mailing Address - Street 1:408 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-4003
Mailing Address - Country:US
Mailing Address - Phone:844-536-9449
Mailing Address - Fax:844-415-1702
Practice Address - Street 1:412 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KS
Practice Address - Zip Code:66060-4008
Practice Address - Country:US
Practice Address - Phone:844-536-9449
Practice Address - Fax:844-415-1702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS08-002682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty