Provider Demographics
NPI:1396883054
Name:MITCHELL COUNTY HOSPITAL HEALTH SYSTEMS
Entity type:Organization
Organization Name:MITCHELL COUNTY HOSPITAL HEALTH SYSTEMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEPKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:785-738-2266
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-0399
Mailing Address - Country:US
Mailing Address - Phone:785-738-9480
Mailing Address - Fax:785-738-9486
Practice Address - Street 1:400 W 8TH ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-1605
Practice Address - Country:US
Practice Address - Phone:785-738-9480
Practice Address - Fax:785-738-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336I0012X
KS2-085853336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100403110AMedicaid
2031502OtherPK