Provider Demographics
NPI:1245576909
Name:CENTRAL CARE, PA
Entity Type:Organization
Organization Name:CENTRAL CARE, PA
Other - Org Name:CENTRAL CARE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-823-0633
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:785-823-0633
Mailing Address - Fax:844-854-4662
Practice Address - Street 1:305 W 15TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2455
Practice Address - Country:US
Practice Address - Phone:620-624-4700
Practice Address - Fax:888-235-3625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL CARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-27
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100143020CMedicaid
NE10026517302Medicaid
OK200480600BMedicaid
OK200480600BMedicaid