Healthcare Provider Details

I. General information

NPI: 1013004225
Provider Name (Legal Business Name): J C H CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N MAIN ST
MEDICINE LODGE KS
67104
US

IV. Provider business mailing address

126 N. MAIN
MEDICINE LODGE KS
67104
US

V. Phone/Fax

Practice location:
  • Phone: 620-886-5161
  • Fax: 620-886-5517
Mailing address:
  • Phone: 620-886-5161
  • Fax: 620-886-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number210402
License Number StateKS

VIII. Authorized Official

Name: JOHN HAGOOD
Title or Position: SECT AND TREAS OF JCH
Credential:
Phone: 620-886-5161