Healthcare Provider Details

I. General information

NPI: 1124049937
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 19TH ST
MARYSVILLE KS
66508-1358
US

IV. Provider business mailing address

808 N 19TH ST
MARYSVILLE KS
66508-1358
US

V. Phone/Fax

Practice location:
  • Phone: 785-562-2303
  • Fax: 785-562-2034
Mailing address:
  • Phone: 785-562-2303
  • Fax: 785-562-2034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESE M LANDOLL
Title or Position: CFO
Credential:
Phone: 785-562-2311