Provider Demographics
NPI:1386732998
Name:MEDICALODGES, INC.
Entity type:Organization
Organization Name:MEDICALODGES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-251-6700
Mailing Address - Street 1:501 EASY ST
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-9211
Mailing Address - Country:US
Mailing Address - Phone:316-794-8635
Mailing Address - Fax:316-794-3476
Practice Address - Street 1:501 EASY ST
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-9211
Practice Address - Country:US
Practice Address - Phone:316-794-8635
Practice Address - Fax:316-794-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087012314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107980AMedicaid
KS0411980014Medicare NSC
KS100107980AMedicaid