Basic Information
| Provider Information | |||||||||
| NPI: | 1225588379 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LINDSBORG COMMUNITY HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LINDSBORG COMMUNITY HOSPITAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 W LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | LINDSBORG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674562328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852273308 | ||||||||
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| Practice Location | |||||||||
| Address1: | 117 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | LARNED | ||||||||
| State: | KS | ||||||||
| PostalCode: | 675503045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202856011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2016 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | VAN DER WEGE | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7852273308 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LINDSBORG COMMUNITY HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | H-059-001 | KS | N | Hospitals | General Acute Care Hospital | Critical Access | 207Q00000X | H-059-001 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 016774 | 01 | KS | MEDICARE ID - TYPE UNSPECIFIED | OTHER |