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General NPI Number Information
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NPI Number | 1295284842
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Entity Type | Organization
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Legal Business Name | COFFEYVILLE REGIONAL MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 122 W MYRTLE ST LOWR LEVEL
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City | INDEPENDENCE
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State | KS
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Zip | 67301-3317
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Country | US
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Telephone | 620-577-4062
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Fax | 620-577-4064
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Provider Business Mailing Address
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Address Line | 1400 W 4TH ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-3306
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Country | US
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Telephone | 620-251-1200
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Fax | 620-252-1181
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Authorized Official
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Title or Position | CEO
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Name | BRIAN LAWRENCE
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Credential |
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Telephone | 620-251-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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