Provider Demographics
NPI:1275504839
Name:COMMUNITY HEALTHCARE SYSTEM, INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE SYSTEM, INC
Other - Org Name:ST MARYS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
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 1:206 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-1637
Mailing Address - Country:US
Mailing Address - Phone:785-437-3734
Mailing Address - Fax:785-437-6186
Practice Address - Street 1:206 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536-1637
Practice Address - Country:US
Practice Address - Phone:785-437-3734
Practice Address - Fax:785-437-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH075001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100110130BMedicaid
KS001440OtherBCBS PLAN 65
KS100110130BMedicaid