Provider Demographics
NPI:1407108335
Name:ATCHISON COMMUNITY HEALTH CLINIC, INC.
Entity Type:Organization
Organization Name:ATCHISON COMMUNITY HEALTH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-367-4879
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-0027
Mailing Address - Country:US
Mailing Address - Phone:913-367-4879
Mailing Address - Fax:913-367-0240
Practice Address - Street 1:1412 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1203
Practice Address - Country:US
Practice Address - Phone:913-367-4879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200738440CMedicaid