Healthcare Provider Details

I. General information

NPI: 1003108440
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 5TH STREET
CORNING KS
66417
US

IV. Provider business mailing address

6221 5TH STREET
CORNING KS
66417
US

V. Phone/Fax

Practice location:
  • Phone: 785-857-3334
  • Fax: 785-857-3397
Mailing address:
  • Phone: 785-857-3334
  • Fax: 785-857-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH075001
License Number StateKS

VIII. Authorized Official

Name: MR. TODD M WILLERT
Title or Position: CEO
Credential:
Phone: 785-889-5002