Provider Demographics
NPI:1093771776
Name:COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE SYSTEM, INC
Other - Org Name:COMMUNITY RURAL HEALTH CLINICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-889-5002
Mailing Address - Street 1:120 W 8TH ST
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521-9574
Mailing Address - Country:US
Mailing Address - Phone:785-889-4274
Mailing Address - Fax:785-889-7163
Practice Address - Street 1:120 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521-9574
Practice Address - Country:US
Practice Address - Phone:785-889-4274
Practice Address - Fax:785-889-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-06-02
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
KS110428OtherBLUE SHIELD
KS100002650CMedicaid
KSCG3859OtherMEDICARE RAILROAD
KS110428Medicare Oscar/Certification
KS100002650CMedicaid