Provider Demographics
NPI:1306578679
Name:GRISELL MEMORIAL HOSPTIAL RHC
Entity type:Organization
Organization Name:GRISELL MEMORIAL HOSPTIAL RHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN OFFICE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASGALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-731-2295
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:NESS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67560-0345
Mailing Address - Country:US
Mailing Address - Phone:785-798-5663
Mailing Address - Fax:
Practice Address - Street 1:210 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:RANSOM
Practice Address - State:KS
Practice Address - Zip Code:67572-9525
Practice Address - Country:US
Practice Address - Phone:785-731-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1295369536OtherNPI