Provider Demographics
NPI:1699762559
Name:METHODIST HOSPITAL ASSOCIATION INC.
Entity type:Organization
Organization Name:METHODIST HOSPITAL ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-227-8551
Mailing Address - Street 1:510 W FRONTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2213
Mailing Address - Country:US
Mailing Address - Phone:620-227-8551
Mailing Address - Fax:620-225-8630
Practice Address - Street 1:510 W FRONTVIEW ST
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2213
Practice Address - Country:US
Practice Address - Phone:620-227-8551
Practice Address - Fax:620-225-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN029001261QA0600X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100108190AMedicaid
KS1278OtherBCBS KS
KS100009660BMedicaid
KS100009660BMedicaid