Healthcare Provider Details

I. General information

NPI: 1720059389
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 W 4TH ST
HOLTON KS
66436-1153
US

IV. Provider business mailing address

1603 W 4TH ST
HOLTON KS
66436-1153
US

V. Phone/Fax

Practice location:
  • Phone: 785-364-3205
  • Fax: 785-364-3468
Mailing address:
  • Phone: 785-364-3205
  • Fax: 785-364-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH075001
License Number StateKS

VIII. Authorized Official

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