Provider Demographics
NPI:1457448110
Name:CITIZENS MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:CITIZENS MEDICAL CENTER, INC
Other - Org Name:FAMILY CENTER FOR HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-462-6184
Mailing Address - Street 1:310 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3716
Mailing Address - Country:US
Mailing Address - Phone:785-462-6184
Mailing Address - Fax:785-460-1490
Practice Address - Street 1:310 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3716
Practice Address - Country:US
Practice Address - Phone:785-462-6184
Practice Address - Fax:785-460-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098840BMedicaid
KS016830Medicare PIN