MEDICARE: COMMUNITY MEMORIAL HEALTHCARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	H058001	KS
2	261QP2300X	Primary Care Clinic/Center	H058001	KS

General Provider Information

NPI Number	:	1568753051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEMORIAL HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	708 N 18TH ST
Second Line	:
City	:	MARYSVILLE
State	:	KS
Zip	:	66508-1338
Country	:	US
Telephone Number	:	785-562-2311
Fax Number	:	785-562-2348

Provider Business Practice Location Address
First Line	:	800 N LOCUST ST
Second Line	:
City	:	FRANKFORT
State	:	KS
Zip	:	66427-1230
Country	:	US
Telephone Number	:	785-562-2311
Fax Number	:	785-562-2348

Authorized Official
Title or Position	:	CEO
Name	:	MR. CURTIS R HAWKINSON
Credential	:
Telephone Number	:	785-562-2311

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	05/02/2011

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