Healthcare Provider Details

I. General information

NPI: 1962410241
Provider Name (Legal Business Name): CITIZENS MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S. FRANKLIN AVENUE, CITIZENS MEDICAL CENTER, INC. DBA CITIZENS MEDICAL CENTER LTCU,
COLBY KS
67701
US

IV. Provider business mailing address

1625 S FRANKLIN AVE
COLBY KS
67701-3722
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-8295
  • Fax: 785-460-1435
Mailing address:
  • Phone: 785-462-8295
  • Fax: 785-460-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberH097101
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. GREG UNRUH
Title or Position: CEO
Credential:
Phone: 785-460-4801