Provider Demographics
NPI:1174568257
Name:JEFFERSON COUNTY MEMORIAL HOSPITAL, INC
Entity type:Organization
Organization Name:JEFFERSON COUNTY MEMORIAL HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-933-4020
Mailing Address - Street 1:408 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-4003
Mailing Address - Country:US
Mailing Address - Phone:913-933-4020
Mailing Address - Fax:844-415-1702
Practice Address - Street 1:408 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KS
Practice Address - Zip Code:66097-4003
Practice Address - Country:US
Practice Address - Phone:913-933-4020
Practice Address - Fax:844-415-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH044001275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001226OtherBCBS SWING BED
KS17Z314Medicare Oscar/Certification