Provider Demographics
NPI:1003682956
Name:COMMUNITY MEMORIAL HEALTHCARE, INC
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC
Other - Org Name:COMMUNITY PHYSICIANS CLINIC-AXTELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FEHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-562-4383
Mailing Address - Street 1:708 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1338
Mailing Address - Country:US
Mailing Address - Phone:785-562-3942
Mailing Address - Fax:785-562-5149
Practice Address - Street 1:302 ELM STREET
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:KS
Practice Address - Zip Code:66403
Practice Address - Country:US
Practice Address - Phone:785-736-2460
Practice Address - Fax:785-736-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health