Healthcare Provider Details

I. General information

NPI: 1184615338
Provider Name (Legal Business Name): WICHITA COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 11/24/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E EARL ST
LEOTI KS
67861-9620
US

IV. Provider business mailing address

211 E EARL ST
LEOTI KS
67861-9620
US

V. Phone/Fax

Practice location:
  • Phone: 620-375-2222
  • Fax: 620-375-2248
Mailing address:
  • Phone: 620-375-2222
  • Fax: 620-375-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberH102001
License Number State

VIII. Authorized Official

Name: MRS. AMANDA BAKER
Title or Position: CFO
Credential:
Phone: 620-375-2233