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General NPI Number Information
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NPI Number | 1013849322
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/04/2026
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Provider Practice Location Address
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Address Line | 800 W LAUREL ST
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City | INDEPENDENCE
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State | KS
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Zip | 67301-3211
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Country | US
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Telephone | 620-577-2131
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1832
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City | PITTSBURG
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State | KS
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Zip | 66762-1832
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Country | US
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Telephone | 620-240-5668
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | JIAWEI MONTOJO
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Credential |
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Telephone | 620-240-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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