Fredonia Regional Hospital
Organization Active NPI Rural Health Clinic/Center · Fredonia, KS
NPI 1639957673 · NPPES record last updated Sep 20, 2023
Key facts
- NPI
- 1639957673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FREDONIA REGIONAL HOSPITAL
- Practice address
- 1525 Madison St Ste 2
Fredonia, KS 66736-1704 - Phone
- (620) 378-2068
- Fax
- (620) 378-2312
- NPI assigned
- Sep 20, 2023
- Organization subpart
- No
Authorized official
- Name
- Tracy Lynn Row
- Title
- Business Office Manager
- Phone
- (620) 378-6204
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Change of ownership 1
Practitioners 22
-
Koralyn Dawn Barkman, APRN-C
-
Ashley Houser, D.O.
-
Kelly Odell, APRN
-
Johnathan A Rodriquez, ARNP
-
Tonya Lynn Hill, M.D.
-
Oswaldo Cruz Bacani Sr., M.D.
-
Jennifer Eagleson, APRN
-
Jessica L Evans, NP
-
Lindsay L Forrester, APRN
-
Valorie L Johnson-Hall, CRNA
-
Angela Christine Kingsbury, PMHNP, APRN
-
Margaret Ann Matlock, APRN-C
-
Terry L Morris, D.O.
-
Lacey Dawn Spohn, APRN-C
-
Charles Earl Vanhouden, M.D.
-
Sarah Renee Baker, NP-C
-
Carol G Smith, LCSW
-
Keith A Greiner Jr., M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Rural health clinic certification: CCN 178646
- Legal name
- FREDONIA REGIONAL HOSPITAL
- Doing business as
- DRS. MORRIS AND HILL MEDICAL CLINIC
- Organization structure
- Government · Non-profit
- Incorporated
- Oct 1, 1985 in KS
- Enrollment address
- 1525 Madison St
Ste 2
Fredonia, KS 66736-1704
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Joseph Morris |
Corporate Officer |
Aug 1, 2019 | |
| Susan John |
Corporate Officer |
Aug 1, 2023 | |
| Charlotte S Svaty |
Corporate Officer |
Aug 1, 2021 | |
| Jennifer Friend |
W-2 Managing Employee |
Aug 26, 2015 | |
| Gaston Millar |
Corporate Officer |
Aug 1, 2020 | |
| Tracy Row |
W-2 Managing Employee |
Nov 28, 2005 | |
| Jennifer E Jensik |
Corporate Officer |
Aug 1, 2020 | |
| Fredonia Regional Hospital |
5% Or Greater Direct Ownership Interest | Nov 4, 2023 | 100% |
| Operational/Managerial Control | Nov 4, 2023 | 100% | |
| Johnathan Durrett |
Corporate Officer |
Jul 16, 2018 | |
| W-2 Managing Employee |
Jul 16, 2018 | ||
| Evan Wayne Dunn |
Corporate Officer |
Aug 1, 2021 | |
| Jennifer Lawrence |
W-2 Managing Employee |
Aug 26, 2015 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Nov 4, 2023 | Change of Ownership |
DRS. Morris & Hill Medical Clinic, LLC |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231214000434 | KS | Part a Provider - Rural Health Clinic | 5294783270 | Practice locations: Fredonia, KS |
National Provider Directory
- Tax ID family
- Fredonia Regional EMS
Locations
1525 Madison St
Ste 2
Fredonia, KS 66736
Phone (620) 378-2068
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1525 Madison St Ste 2
Fredonia, KS 66736-1704
Mailing address
PO Box 579
Fredonia, KS 66736-0579
Phone (620) 378-2121
Other names
- Drs. Morris and Hill Medical Clinic
Other providers in Fredonia, KS
- Fredonia Regional Hospital
- Fredonia Regional Hospital
- Fredonia Regional Hospital
- Fredonia Regional Hospital
- Fredonia Regional Hospital
- William J Garey
- Kiley Green
- Grene Vision Group LLC
- Handshy Medical Clinic LLC
- Handshy Medical Clinic, LLC
All providers in Fredonia, KS · Rural Health 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 Sep 20, 2023. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.