Organization
JEFFERSON COUNTY MEMORIAL HOSPITAL
Active
Other names
FW Huston Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAMONT COOK (CEO)
(913) 774-4340
Entity
Organization
Contact information
Practice address
504 PLAZA DR, SUITE 300, PERRY, KS 66073-4136
(913) 774-4340
(913) 774-3379
Mailing address
408 DELAWARE ST, WINCHESTER, KS 66097-4003
(913) 774-4340
(913) 774-3379
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100080370F
—
KS
01
—
110046
MEDICARE ID-TYPE UNSPECIFIED
KS
Enumeration date
04/30/2014
Last updated
06/23/2014
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