# MEDICINE LODGE MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083702369
- **Authorized official:** MS. ASHLEY TAYLOR (ADMINISTRATOR)
- **Authorized official phone:** (620) 886-3771

## Contact information

- **Practice address:** 710 N. WALNUT ST., DRAWER 'C', MEDICINE LODGE, KS 67104-1019
- **Practice address phone:** (620) 930-3744
- **Practice address fax:** (620) 930-3784
- **Mailing address:** 710 N. WALNUT ST., DRAWERE 'C', MEDICINE LODGE, KS 67104-1019
- **Mailing address phone:** (620) 930-3744
- **Mailing address fax:** (620) 930-3784

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC0050X | Critical Access Hospital Clinic/Center | HS004002 | KS | Yes |
| 261QR1300X | Rural Health Clinic/Center | H004002 | KS | — |

## Other

- **Enumeration date:** 10/11/2006
- **Last updated:** 07/02/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100092110B | — | KS |