Healthcare Provider Details

I. General information

NPI: 1407108335
Provider Name (Legal Business Name): ATCHISON COMMUNITY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 COMMERCIAL ST
ATCHISON KS
66002-2419
US

IV. Provider business mailing address

1412 N 2ND ST
ATCHISON KS
66002-1203
US

V. Phone/Fax

Practice location:
  • Phone: 913-367-4879
  • Fax: 913-367-0240
Mailing address:
  • Phone: 913-367-4879
  • Fax: 913-367-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANDI OOM
Title or Position: CEO
Credential:
Phone: 913-367-4879