Healthcare Provider Details

I. General information

NPI: 1710422795
Provider Name (Legal Business Name): COMMONSPIRIT KANSAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date: 06/02/2025
Reactivation Date: 06/25/2025

III. Provider practice location address

505 N MAIN ST
ULYSSES KS
67880-2135
US

IV. Provider business mailing address

PO BOX 803929
KANSAS CITY MO
64180-3929
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-1266
  • Fax: 620-356-3846
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. TADD RICHERT
Title or Position: REGION CHIEF FINANCIAL OFFICER
Credential:
Phone: 303-673-7864