Provider Demographics
NPI:1871546259
Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Entity type:Organization
Organization Name:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINGENPEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-649-2761
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-0159
Mailing Address - Country:US
Mailing Address - Phone:620-649-2761
Mailing Address - Fax:620-649-2776
Practice Address - Street 1:301 S. DERBY
Practice Address - Street 2:
Practice Address - City:SUBLETTE
Practice Address - State:KS
Practice Address - Zip Code:67877-0398
Practice Address - Country:US
Practice Address - Phone:620-675-8191
Practice Address - Fax:620-675-2236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14267251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080490DMedicaid
KS119954OtherBLUE CROSS
KS17D0882657OtherCLIA #
KS17D0882657OtherCLIA #