Healthcare Provider Details

I. General information

NPI: 1366407744
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W 8TH ST
ONAGA KS
66521-9574
US

IV. Provider business mailing address

100 W 8TH ST PO BOX 460
ONAGA KS
66521-9574
US

V. Phone/Fax

Practice location:
  • Phone: 785-889-7200
  • Fax: 785-889-4808
Mailing address:
  • Phone: 785-889-4274
  • Fax: 785-889-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA075005
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100067410C
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

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