Provider Demographics
NPI:1306860713
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:COMMUNITY MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-562-2311
Mailing Address - Street 1:805 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1802
Mailing Address - Country:US
Mailing Address - Phone:785-562-2858
Mailing Address - Fax:785-562-2850
Practice Address - Street 1:805 BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1802
Practice Address - Country:US
Practice Address - Phone:785-562-2858
Practice Address - Fax:785-562-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10201OtherBLUE CROSS/BLUE SHIELD KS
KS100005390LMedicaid
KS10201OtherBLUE CROSS/BLUE SHIELD KS
KS100005390LMedicaid
NE=========020OtherBLUE CROSS/BLUE SHIELD