1083199392 NPI number — COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083199392 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:
Provider Other Organization Name Type Code:
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:
1083199392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2018
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:
620-240-5062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARMA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66712-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-9873
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CREITZ
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
SPENCER
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
620-240-5015

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)





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