NPIMap

Walgreen Co

Organization Active NPI Pharmacy · Fort Scott, KS

NPI 1366633570 · NPPES record last updated Nov 6, 2023

Key facts

NPI
1366633570
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
2-13132 (KS)
Legal business name
WALGREEN CO
Practice address
2229 S. Main St.
Fort Scott, KS 66701-3023
Phone
(620) 223-2402
Fax
(620) 223-4954
NPI assigned
Aug 5, 2007
Organization subpart
Yes
Parent organization (as reported)
WALGREENS BOOTS ALLIANCE INC

Authorized official

Name
Kira L Taylor
Title
Manager
Phone
(217) 709-2351

Member of 16

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 5

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX, KS

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment
O20201208001995 KS Part B Supplier - Independent Clinical Laboratory 0941278253 This NPI is an additional NPI on the enrollment

National Provider Directory

Part of
Walgreens Holding Company

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 2-13132 KS Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

2229 S. Main St.
Fort Scott, KS 66701-3023

Mailing address

1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351

Other identifiers

IdentifierTypeStateIssuer
1719218OtherNCPDP
100242740NOtherOKMEDICAID DME
100432200EMedicaidKS
100242740LMedicaidOK
100432200F DMEMedicaidKS

Other names

  • WALGREENS #11086 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 6, 2023.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699228800000",
    "number": "1366633570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MS 790",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "217-709-2351",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2229 S. MAIN ST.",
            "city": "FORT SCOTT",
            "state": "KS",
            "postal_code": "667013023",
            "telephone_number": "620-223-2402",
            "fax_number": "620-223-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2007-08-05",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KIRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-709-2351"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "KS",
            "license": "2-13132",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1719218",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "100242740N",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100432200E",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100242740L",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100432200F DME",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #11086",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #11086",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Scott, KS

All providers in Fort Scott, KS · Pharmacy in Kansas

Sources for this page

Verify at the official NPI Registry.