Healthcare Provider Details

I. General information

NPI: 1780040238
Provider Name (Legal Business Name): CITIZENS MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E COLLEGE DR
COLBY KS
67701-3702
US

IV. Provider business mailing address

100 E COLLEGE DR
COLBY KS
67701-3702
US

V. Phone/Fax

Practice location:
  • Phone: 785-460-1266
  • Fax:
Mailing address:
  • Phone: 785-460-1266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2-08640
License Number StateKS

VIII. Authorized Official

Name: JOHNNIE BARTON
Title or Position: CERTIFIED PHARMACY TECHNICIAN
Credential:
Phone: 785-460-1266