Provider Demographics
NPI:1386678530
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:BLUE RAPIDS 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 1:607 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BLUE RAPIDS
Mailing Address - State:KS
Mailing Address - Zip Code:66411-1419
Mailing Address - Country:US
Mailing Address - Phone:785-363-7202
Mailing Address - Fax:785-363-7630
Practice Address - Street 1:607 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BLUE RAPIDS
Practice Address - State:KS
Practice Address - Zip Code:66411-1419
Practice Address - Country:US
Practice Address - Phone:785-363-7202
Practice Address - Fax:785-363-7630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEMORIAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-11
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016888OtherBLUE CROSS/BLUE SHIELD KS
CB2663OtherRAILROAD MEDICARE
KS016888OtherBLUE CROSS/BLUE SHIELD KS
CB2663OtherRAILROAD MEDICARE