Healthcare Provider Details

I. General information

NPI: 1457448110
Provider Name (Legal Business Name): CITIZENS MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E COLLEGE DR
COLBY KS
67701-3716
US

IV. Provider business mailing address

310 E COLLEGE DR
COLBY KS
67701-3716
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-6184
  • Fax: 785-460-1490
Mailing address:
  • Phone: 785-462-6184
  • Fax: 785-460-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT R FOCKE
Title or Position: CLINIC MANAGER
Credential:
Phone: 785-462-6184