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NPI Code Detail

MEDICARE: COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.

MEDICARE: COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1386294213
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Provider Business Mailing Address
First Line : 3011 N MICHIGAN ST
Second Line :
City : PITTSBURG
State : KS
Zip : 66762-2546
Country : US
Telephone Number : 620-231-9873
Fax Number : 620-240-5062
Provider Business Practice Location Address
First Line : 106 NW VETERANS BLVD
Second Line :
City : MIAMI
State : OK
Zip : 74354-1818
Country : US
Telephone Number : 620-231-9873
Fax Number :
Authorized Official
Title or Position : GENERAL COUNSEL
Name : DANIEL SPENCER CREITZ
Credential :
Telephone Number : 620-240-5015
Provider Enumeration Date : 09/12/2019
Last Update Date : 01/07/2021

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Directions to “COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC. ” Practice Location

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