1972794402 NPI number — COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.

Table of content: (NPI 1972794402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972794402 NPI number — COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS/COLUMBUS CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972794402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3011 N MICHIGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURG
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66762-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-231-9873
Provider Business Mailing Address Fax Number:
620-231-2808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W SYCAMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66725-1276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-249-2101
Provider Business Practice Location Address Fax Number:
620-429-2106
Provider Enumeration Date:
08/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POSTAI
Authorized Official First Name:
KRISTA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
620-231-9873

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 468481 . This is a "CHILDRENS MERCY FHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17-1821 . This is a "NGS NAT. GOV. SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100456320E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200099190C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100456320W , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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