Provider Demographics
NPI: | 1801208053 |
---|---|
Name: | COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC |
Entity type: | Organization |
Organization Name: | COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTA |
Authorized Official - Middle Name: | K |
Authorized Official - Last Name: | POSTAI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 620-231-9873 |
Mailing Address - Street 1: | 3011 N MICHIGAN ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSBURG |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 66762-2546 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 620-231-9873 |
Mailing Address - Fax: | 620-231-2808 |
Practice Address - Street 1: | 3354 HIGHWAY 160 |
Practice Address - Street 2: | |
Practice Address - City: | INDEPENDENCE |
Practice Address - State: | KS |
Practice Address - Zip Code: | 67301-7841 |
Practice Address - Country: | US |
Practice Address - Phone: | 620-231-1748 |
Practice Address - Fax: | 620-332-1940 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-05-22 |
Last Update Date: | 2021-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |