Provider Demographics
NPI:1265739288
Name:JEFFERSON COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:JEFFERSON COUNTY MEMORIAL HOSPITAL
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:913-774-4340
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:913-774-4340
Mailing Address - Fax:913-774-3379
Practice Address - Street 1:409 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VALLEY FALLS
Practice Address - State:KS
Practice Address - Zip Code:66088-1303
Practice Address - Country:US
Practice Address - Phone:913-774-4340
Practice Address - Fax:913-774-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty