Provider Demographics
NPI:1558830182
Name:COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:CREITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-240-5015
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:620-231-9873
Mailing Address - Fax:620-240-5062
Practice Address - Street 1:302 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:KS
Practice Address - Zip Code:66056-5279
Practice Address - Country:US
Practice Address - Phone:913-795-8302
Practice Address - Fax:913-795-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)