NPIMap

Organization Active NPI

Greenwood County Hospital

Doing business as Eureka Clinic

  • Rural Health Clinic/Center
  • Eureka, KS
National Provider Identifier
1215045299
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GREENWOOD COUNTY HOSPITAL
Doing business as
Eureka Clinic
Practice address
1602 N Elm St Ste B
Eureka, KS 67045-1092
Phone
(620) 583-5274
Fax
(620) 583-5194
NPI assigned
Aug 29, 2006
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GREENWOOD COUNTY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Nancy J McKenzieNPI 1891780086
Title
Ceo
Phone
(620) 583-7451

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1602 N Elm St Ste B
Eureka, KS 67045-1092

Mailing address

100 West 16TH St.
Eureka, KS 67045-1047
Phone (620) 583-5274

Other identifiers 1

IdentifierTypeStateIssuer
100070000GMedicaidKS

Other names 1

  • Eureka Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070417000276 KS Part A Provider - Rural Health Clinic 0042129603 Practice locations: Eureka, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215045299. Details of each certification follow.

Rural health clinic certification: CCN 178544

Legal name
GREENWOOD COUNTY HOSPITAL
Doing business as
EUREKA CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 1, 2007
Last certification
Feb 15, 2017
Ownership / control type
Non-profit – church related
Most recent change of ownership
Mar 2, 2007 (1 total)
Organization structure
GovernmentNon-profit
Incorporated
Mar 1, 2007 in KS
Enrollment address
1602 N Elm St
Ste B
Eureka, KS 67045-1092
Related CCNs
171339

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

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D2083009Greenwood County Hospital Dba Eureka Clinic1602 N Elm St Ste B, Eureka, KS 67045Certificate of waiverAug 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Greenwood County HSP-Crna8 organizations share this tax ID, including this one
Part of
Greenwood County HSP-Crna

Other organizations with this tax ID 7

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

Member of 1

Organizations this organization is a member of, according to 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
Sandra K Dickerson Individual Corporate OfficerCeo Aug 1, 2017
W-2 Managing EmployeeCeo Aug 1, 2017
County of Greenwood Organization, Eureka, KS 5% Or Greater Direct Ownership Interest Mar 1, 2007 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Greenwood County Home Health AgencyEureka, KS, CCN 177243 Home health agency Other (100%) Apr 15, 1993

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1215045299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 WEST 16TH ST.",
            "city": "EUREKA",
            "state": "KS",
            "postal_code": "670451047",
            "telephone_number": "620-583-5274",
            "fax_number": "620-583-5194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1602 N ELM ST STE B",
            "city": "EUREKA",
            "state": "KS",
            "postal_code": "670451092",
            "telephone_number": "620-583-5274",
            "fax_number": "620-583-5194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWOOD COUNTY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREENWOOD COUNTY HOSPITAL",
        "enumeration_date": "2006-08-29",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "MCKENZIE",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "620-583-7451"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100070000G",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eureka Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eureka, KS

Sources for this page

Verify at the official NPI Registry.