Healthcare Provider Details

I. General information

NPI: 1851876163
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 S NATIONAL AVE
FORT SCOTT KS
66701-2645
US

IV. Provider business mailing address

3011 N MICHIGAN ST
PITTSBURG KS
66762-2546
US

V. Phone/Fax

Practice location:
  • Phone: 620-231-9873
  • Fax:
Mailing address:
  • Phone: 620-231-9873
  • Fax: 620-231-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL SPENCER CREITZ
Title or Position: GENERAL COUNSEL
Credential:
Phone: 620-240-5015