Provider Demographics
NPI:1184612657
Name:COFFEY COUNTY HOSPITAL
Entity type:Organization
Organization Name:COFFEY COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-364-2121
Mailing Address - Street 1:128 SOUTH PEARSON AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:KS
Mailing Address - Zip Code:66871
Mailing Address - Country:US
Mailing Address - Phone:785-733-2744
Mailing Address - Fax:785-733-2514
Practice Address - Street 1:128 S PEARSON AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:KS
Practice Address - Zip Code:66871-9673
Practice Address - Country:US
Practice Address - Phone:785-733-2744
Practice Address - Fax:785-733-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility