Provider Demographics
NPI:1316999246
Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Entity type:Organization
Organization Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINGENPEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-649-2761
Mailing Address - Street 1:401 CHEYENNE
Mailing Address - Street 2:
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-0159
Mailing Address - Country:US
Mailing Address - Phone:620-649-2771
Mailing Address - Fax:620-649-2538
Practice Address - Street 1:410 CHEYENNE
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-8748
Practice Address - Country:US
Practice Address - Phone:620-649-2771
Practice Address - Fax:620-649-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 363L00000X
KSH-041-001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSOO1326OtherBLUE CROSS #
KS100080490BMedicaid
KS100262240AMedicaid
KS100080490BMedicaid