Healthcare Provider Details

I. General information

NPI: 1467564039
Provider Name (Legal Business Name): MERCY KANSAS COMMUNITIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN ST
CHERRYVALE KS
67335-1332
US

IV. Provider business mailing address

PO BOX 414 203 WEST MAIN STREET
CHERRYVALE KS
67335-0414
US

V. Phone/Fax

Practice location:
  • Phone: 620-336-2132
  • Fax: 620-336-2237
Mailing address:
  • Phone: 620-336-2132
  • Fax: 620-336-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number1500335
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1500335
License Number StateKS

VIII. Authorized Official

Name: MRS. SHELLY HUNTER
Title or Position: CFO
Credential:
Phone: 417-625-2459