Healthcare Provider Details

I. General information

NPI: 1710107453
Provider Name (Legal Business Name): COLBY COMMUNITY COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S RANGE AVE
COLBY KS
67701
US

IV. Provider business mailing address

1255 SO RANGE AVE
COLBY KS
67701
US

V. Phone/Fax

Practice location:
  • Phone: 785-460-5502
  • Fax: 785-460-4691
Mailing address:
  • Phone: 785-460-5502
  • Fax: 785-460-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BREWSTER A KELLOGG
Title or Position: MEDICAL DIRECTOR OF STUDENT HEALTH
Credential: DO
Phone: 785-460-5502