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CAH171334-00 Medicine Lodge Memorial Hospital (Active)
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Main Details
Name
Medicine Lodge Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH171334-00
Medicare Provider Number
171334
Additional Details
Current Program Status
Active
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/6/2013
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Medicine Lodge Memorial Hospital
Jennifer Bowe, CFO
(620) 930-3702
Primary Contact
Medicine Lodge Memorial Hospital
Ashley Taylor, Clinic Director
(620) 930-3705
Addresses
Street Address
710 N. Walnut
Medicine Lodge, KS 67104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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