Provider Demographics
NPI:1164203717
Name:SOUTHEAST KANSAS MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHEAST KANSAS MENTAL HEALTH CENTER
Other - Org Name:ASHLEY CLINIC LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OFFICE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-365-8641
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-0039
Mailing Address - Country:US
Mailing Address - Phone:620-473-2241
Mailing Address - Fax:620-473-3334
Practice Address - Street 1:505 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1950
Practice Address - Country:US
Practice Address - Phone:620-431-2500
Practice Address - Fax:620-431-4418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST KANSAS MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-10
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory