Healthcare Provider Details

I. General information

NPI: 1487638540
Provider Name (Legal Business Name): HEALTH MANAGEMENT OF KANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 W 1ST ST
COFFEYVILLE KS
67337-2441
US

IV. Provider business mailing address

2921 W 1ST ST
COFFEYVILLE KS
67337-2441
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-5190
  • Fax: 620-251-5029
Mailing address:
  • Phone: 620-251-5190
  • Fax: 620-251-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN-063-010
License Number StateKS

VIII. Authorized Official

Name: MONTE COFFMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 620-251-5190