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Stafford County Hospital

Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Stafford, KS

NPI 1437258779 · NPPES record last updated Feb 12, 2009

Key facts

NPI
1437258779
Entity type
Organization (NPI type 2)
Primary specialty
Medicare Defined Swing Bed Hospital Unit 275N00000X
License
H-093-002 (KS)
Legal business name
STAFFORD COUNTY HOSPITAL
Practice address
502 South Buckeye Street
Stafford, KS 67578-0190
Phone
(620) 234-5221
Fax
(620) 234-5792
NPI assigned
Sep 22, 2006
Organization subpart
No

Authorized official

Name
Janell Goodno
Title
Cfo
Phone
(620) 234-5221

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 1

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

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

Practitioners 11

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

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KS

Hospital certification: CCN 17Z323

Legal name
STAFFORD COUNTY HOSPITAL
Organization structure
Government · Non-profit
Enrollment address
502 S Buckeye St
Stafford, KS 67578-2035
Main/Primary Hospital Location

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Tracy Fanshier
Individual 		Corporate Director Jan 1, 2012
Stafford County Hospital
Organization · Stafford, KS
Non-profit 		Operational/Managerial Control Dec 1, 2011
Mary Hildebrand
Individual 		Corporate Director Apr 26, 2006
Boyd Volker
Individual 		Corporate Director
Board Member		 Jan 1, 2012
Ruth Teichman
Individual 		Corporate Director Mar 18, 2013
Todd S Taylor
Individual 		Corporate Officer
Administrator		 Jun 1, 2012
W-2 Managing Employee
Administrator		 Jun 1, 2012
Jo R Caley
Individual 		Corporate Officer
Assistant Administrator		 Jun 1, 2012
W-2 Managing Employee
Assistant Administrator		 Jun 1, 2012

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070228000176 KS Part a Provider - Critical Access Hospital 3678583382 Practice locations: Stafford, KS

National Provider Directory

Locations

502 S Buckeye St
Stafford, KS 67578
Phone (620) 234-5221

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X H-093-002 KS Yes

Addresses

Primary practice location

502 South Buckeye Street
Stafford, KS 67578-0190

Mailing address

502 South Buckeye Street
Stafford, KS 67578-0190
Phone (620) 234-5221

Other providers in Stafford, KS

All providers in Stafford, KS · Medicare Defined Swing Bed Hospital Unit in Kansas

Sources for this page

Verify at the official NPI Registry.