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General NPI Number Information
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NPI Number | 1851876163
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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 | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 1624 S NATIONAL AVE
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City | FORT SCOTT
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State | KS
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Zip | 66701-2645
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Country | US
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Telephone | 620-231-9873
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Fax |
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Provider Business Mailing Address
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Address Line | 3011 N MICHIGAN ST
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City | PITTSBURG
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State | KS
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Zip | 66762-2546
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Country | US
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Telephone | 620-231-9873
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Fax | 620-231-5062
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | DANIEL SPENCER CREITZ
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Credential |
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Telephone | 620-240-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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