Provider Demographics
NPI:1518107044
Name:CAH ACQUISITION COMPANY 6 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 6 LLC
Other - Org Name:I-70 MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCUTCHEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-335-4700
Mailing Address - Street 1:105 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-2229
Mailing Address - Country:US
Mailing Address - Phone:660-335-4700
Mailing Address - Fax:660-335-7487
Practice Address - Street 1:105 E HOSPITAL DR
Practice Address - Street 2:BLDG B
Practice Address - City:SWEET SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65351
Practice Address - Country:US
Practice Address - Phone:660-335-7074
Practice Address - Fax:660-335-9955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAH ACQUISITION COMPANY 6 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-24
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268599Medicare Oscar/Certification
MO268599Medicare Oscar/Certification
MOT920000OtherMEDICARE NON-RHC
MO36651021OtherBCBS
MO261334Medicare Oscar/Certification
MO91264026OtherBCBS
MOW050000Medicare Oscar/Certification