Provider Demographics
NPI:1376578096
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:SUMMERFIELD MEDICAL CLINIC
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:66541-0096
Mailing Address - Country:US
Mailing Address - Phone:785-244-6410
Mailing Address - Fax:785-244-6409
Practice Address - Street 1:102 E BETHELL
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:KS
Practice Address - Zip Code:66541
Practice Address - Country:US
Practice Address - Phone:785-244-6410
Practice Address - Fax:785-244-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016863OtherBLUE CROSS/BLUE SHIELD KS
NE=========03Medicaid
KS016863OtherBLUE CROSS/BLUE SHIELD KS
KS17-3424Medicare Oscar/Certification
NE=========03Medicaid