Provider Demographics
NPI:1467564039
Name:MERCY KANSAS COMMUNITIES INC
Entity Type:Organization
Organization Name:MERCY KANSAS COMMUNITIES INC
Other - Org Name:CHERRYVALE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-625-2459
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:203 WEST MAIN STREET
Mailing Address - City:CHERRYVALE
Mailing Address - State:KS
Mailing Address - Zip Code:67335-0414
Mailing Address - Country:US
Mailing Address - Phone:620-336-2132
Mailing Address - Fax:620-336-2237
Practice Address - Street 1:203 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHERRYVALE
Practice Address - State:KS
Practice Address - Zip Code:67335-1332
Practice Address - Country:US
Practice Address - Phone:620-336-2132
Practice Address - Fax:620-336-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500335261QR1300X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089300IMedicaid
KS173421Medicare Oscar/Certification
KS100089300IMedicaid