Provider Demographics
NPI:1225759996
Name:COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:CREITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-240-5015
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1333
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)