Jefferson County Memorial Hospital
Organization Active NPI Multi-Specialty Clinic/Center · Perry, KS
NPI 1447660360 · NPPES record last updated Jun 23, 2014
Key facts
- NPI
- 1447660360
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- JEFFERSON COUNTY MEMORIAL HOSPITAL
- Practice address
- 504 Plaza Dr
Suite 300
Perry, KS 66073-4136 - Phone
- (913) 774-4340
- Fax
- (913) 774-3379
- NPI assigned
- Apr 30, 2014
- Organization subpart
- No
Authorized official
- Name
- Mr. Lamont Cook
- Title
- Ceo
- Phone
- (913) 774-4340
Other NPIs on the same Medicare enrollment 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050215000085 | KS | Part B Supplier - Clinic/Group Practice | 6002868445 |
Receives reassigned benefits from 10 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Winchester, KS; Basehor, KS |
National Provider Directory
Locations
504 Plaza Dr
Ste 300
Perry, KS 66073
Phone (913) 774-4340
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
504 Plaza Dr
Suite 300
Perry, KS 66073-4136
Mailing address
408 Delaware St
Winchester, KS 66097-4003
Phone (913) 774-4340
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110046 | Other | KS | MEDICARE ID-TYPE UNSPECIFIED |
| 100080370F | Medicaid | KS |
Other names
- FW Huston Medical Clinic
Other providers in Perry, KS
- Sandra Bowman
- Complete Chiropractic, Rehab, & Wellness LLC
- Alexander Jospeh Hemme
- Nikolay Kalinichenko
- Perry Lake Wellness Solution Centers, LLC
- Perry Public Schools Usd343
- Plainsmen Health Services Inc.
- Cara Dawn Porter
All providers in Perry, KS · Multi-Specialty Clinic/Center in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.