Provider Demographics
NPI:1003108440
Name:COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE SYSTEM, INC
Other - Org Name:CORNING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-889-5002
Mailing Address - Street 1:6221 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:KS
Mailing Address - Zip Code:66417
Mailing Address - Country:US
Mailing Address - Phone:785-857-3334
Mailing Address - Fax:785-857-3397
Practice Address - Street 1:6221 5TH STREET
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:KS
Practice Address - Zip Code:66417
Practice Address - Country:US
Practice Address - Phone:785-857-3334
Practice Address - Fax:785-857-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH075001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110428Medicare Oscar/Certification