Provider Demographics
NPI:1124363817
Name:ARKANSAS CITY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:ARKANSAS CITY COMMUNITY HEALTH CENTER
Other - Org Name:MAINLINE HEALTH SYSTEMS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAFTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-538-5414
Mailing Address - Street 1:1008 SADIE LEE LANE
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71630
Mailing Address - Country:US
Mailing Address - Phone:870-877-2622
Mailing Address - Fax:870-877-2627
Practice Address - Street 1:1008 SADIE LEE LANE
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:AR
Practice Address - Zip Code:71630
Practice Address - Country:US
Practice Address - Phone:870-877-2622
Practice Address - Fax:870-877-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)