Healthcare Provider Details

I. General information

NPI: 1053406330
Provider Name (Legal Business Name): CITIZENS MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 EAST COLLEGE DRIVE
COLBY KS
67701-3716
US

IV. Provider business mailing address

310 EAST COLLEGE DRIVE
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 TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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