Provider Demographics
NPI:1558394064
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:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLOEMKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-335-4700
Mailing Address - Street 1:105 HOSPITAL DRIVE
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 HOSPITAL DRIVE
Practice Address - Street 2:BLDG B
Practice Address - City:SWEET SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65351-2229
Practice Address - Country:US
Practice Address - Phone:660-335-7074
Practice Address - Fax:660-335-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-06-22
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
MOMA2024Medicare Oscar/Certification
MO501228704Medicaid
MO36651011OtherBCBS GROUP #
MO268599Medicare Oscar/Certification
MOT920000OtherWHEATLANDS, MEDICARE PART