Healthcare Provider Details

I. General information

NPI: 1003682956
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 ELM STREET
AXTELL KS
66403
US

IV. Provider business mailing address

708 N 18TH ST
MARYSVILLE KS
66508-1338
US

V. Phone/Fax

Practice location:
  • Phone: 785-736-2460
  • Fax: 785-736-2461
Mailing address:
  • Phone: 785-562-3942
  • Fax: 785-562-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL WILLIAM FEHR
Title or Position: CFO
Credential:
Phone: 785-562-4383