Healthcare Provider Details

I. General information

NPI: 1215907951
Provider Name (Legal Business Name): WEST CENTRAL KANSAS ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S KANSAS ST
RUSSELL KS
67665-3000
US

IV. Provider business mailing address

200 S MAIN ST BLDG B
RUSSELL KS
67665-2920
US

V. Phone/Fax

Practice location:
  • Phone: 785-483-3131
  • Fax: 785-483-4859
Mailing address:
  • Phone: 785-483-3131
  • Fax: 785-483-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number171350A
License Number StateKS

VIII. Authorized Official

Name: DAVID CAUDILL
Title or Position: CEO
Credential:
Phone: 785-483-0708