Provider Demographics
NPI:1902891500
Name:GREENWOOD COUNTY HOSPITAL
Entity Type:Organization
Organization Name:GREENWOOD COUNTY HOSPITAL
Other - Org Name:BASHAM CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-583-7451
Mailing Address - Street 1:110 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:KS
Mailing Address - Zip Code:67045-1067
Mailing Address - Country:US
Mailing Address - Phone:620-583-7451
Mailing Address - Fax:620-583-6702
Practice Address - Street 1:110 E 16TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:KS
Practice Address - Zip Code:67045-1067
Practice Address - Country:US
Practice Address - Phone:620-583-7451
Practice Address - Fax:620-583-6702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENWOOD COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty