=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710422795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONSPIRIT KANSAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2016
-----------------------------------------------------
Last Update Date | 06/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 N MAIN ST
-----------------------------------------------------
City | ULYSSES
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67880-2135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-356-1266
-----------------------------------------------------
Fax | 620-356-3846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 803929
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64180-3929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-953-0104
-----------------------------------------------------
Fax | 303-765-6670
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGION CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. TADD RICHERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-673-7864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------