=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467413906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREARC, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 02/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 W 15TH AVE
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-5367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-4864
-----------------------------------------------------
Fax | 620-343-3545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 W 15TH AVE
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-5367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-342-4864
-----------------------------------------------------
Fax | 620-343-3545
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MRS. RENEE E HIVELY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-342-4864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | 0427968
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------