Provider Demographics
NPI:1144312844
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:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDERGRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-649-2761
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:SATANTA
Mailing Address - State:KS
Mailing Address - Zip Code:67870-0009
Mailing Address - Country:US
Mailing Address - Phone:620-649-2771
Mailing Address - Fax:620-649-2538
Practice Address - Street 1:410 CHEYENNE STREET
Practice Address - Street 2:
Practice Address - City:SATANTA
Practice Address - State:KS
Practice Address - Zip Code:67870-0009
Practice Address - Country:US
Practice Address - Phone:620-649-2771
Practice Address - Fax:620-649-2538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SATANTA DISTRICT HOSPITAL AND LONG-TERM CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208VP0014X
KSH041001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110220OtherNON RURAL HEALTH NUMBER
KS110220Medicare ID - Type UnspecifiedNON RURAL HEALTH NUMBER