1306860713 NPI number — COMMUNITY MEMORIAL HEALTHCARE, INC.

Table of content: (NPI 1306860713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306860713 NPI number — COMMUNITY MEMORIAL HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY MEMORIAL HEALTHCARE, 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:
6
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:
1306860713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYSVILLE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66508-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-562-2858
Provider Business Mailing Address Fax Number:
785-562-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYSVILLE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66508-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-562-2858
Provider Business Practice Location Address Fax Number:
785-562-2850
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANDOLL
Authorized Official First Name:
THERESE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
785-562-2311

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10201 . This is a "BLUE CROSS/BLUE SHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100005390L , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com