NPIMap

Organization Active NPI

Kiowa District Hospital

  • Rural Health Clinic/Center
  • Kiowa, KS
National Provider Identifier
1093708596
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
178506 Issued in KS
Legal business name
KIOWA DISTRICT HOSPITAL
Practice address
1002 S 4TH St
Kiowa, KS 67070-1825
Phone
(620) 825-4131
Fax
(620) 825-4667
NPI assigned
Aug 30, 2005
Organization subpart
Yes
Parent organization
KIOWA DISTRICT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janell Lyn Goodno
Title
Cfo
Phone
(620) 825-4131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 178506 KS Primary

Addresses

Primary practice location

1002 S 4TH St
Kiowa, KS 67070-1825

Mailing address

810 Drumm St
Kiowa, KS 67070-1626
Phone (620) 825-4131

Other names 1

  • Kiowa District Hospital-Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address KiowaDistrict.Clinic@k-d-h.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041014000588 KS Part A Provider - Rural Health Clinic 8325020670 Practice locations: Kiowa, KS

Rural health clinic certification: CCN 178506

Legal name
KIOWA DISTRICT HOSPITAL
Doing business as
KIOWA DISTRICT HOSPITAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 16, 2003
Last certification
Jun 16, 2026
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Jan 31, 2001 in KS
Enrollment address
1002 S 4TH St
Kiowa, KS 67070-1825
Related CCNs
171331

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Kiowa District Hospital PC4 organizations share this tax ID, including this one
Part of
Kiowa District Hospital PC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Janell L Goodno Individual Corporate DirectorCfo Oct 31, 2011
Operational/Managerial ControlCfo Oct 31, 2011
Patrick E Myers Individual 5% Or Greater Direct Ownership InterestBoard Chairman Jan 1, 2018 5%

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1093708596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 DRUMM ST",
            "city": "KIOWA",
            "state": "KS",
            "postal_code": "670701626",
            "telephone_number": "620-825-4131",
            "fax_number": "620-825-4667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 S 4TH ST",
            "city": "KIOWA",
            "state": "KS",
            "postal_code": "670701825",
            "telephone_number": "620-825-4131",
            "fax_number": "620-825-4667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIOWA DISTRICT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KIOWA DISTRICT HOSPITAL",
        "enumeration_date": "2005-08-30",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "GOODNO",
        "authorized_official_first_name": "JANELL",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "620-825-4131"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": "178506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "KiowaDistrict.Clinic@k-d-h.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1002 S 4th St",
            "city": "Kiowa",
            "state": "KS",
            "country_code": "US",
            "postal_code": "670701825",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kiowa District Hospital-Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kiowa District Hospital-Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kiowa, KS

Sources for this page

Verify at the official NPI Registry.