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CAH171344-03 WILSON MEDICAL CENTER (Active)
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Main Details
Name
WILSON MEDICAL CENTER
Subdivision Name
WILSON COUNTY HOSPITAL DBA NEODESHA FAMILY MEDICINE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH171344-03
Medicare Provider Number
171344
Outpatient Facility Provider Number
178610
Additional Details
Current Program Status
Active
Registration Date
4/16/2018
Participating Start Date
7/1/2018
Participating Approval Date
6/12/2018
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Wilson County Hospital
Lori Smith, CFO
(620) 325-8388
Primary Contact
WILSON COUNTY HOSPITAL
Travis A Coffield, Pharmacy Director
(620) 325-8334
Addresses
Street Address
2600 Ottawa Rd
Suite 101
NEODESHA, KS 66757-1897
Billing Address
Wilson Medical Center
2600 Ottawa RD
Neodesha, KS 66757
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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