Provider Demographics
NPI:1598949364
Name:CAH ACQUISITION COMPANY 3 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 3 LLC
Other - Org Name:HORTON RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-879-4357
Mailing Address - Street 1:240 W. 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:KS
Mailing Address - Zip Code:66439-1245
Mailing Address - Country:US
Mailing Address - Phone:785-879-4357
Mailing Address - Fax:785-879-4406
Practice Address - Street 1:1903 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:KS
Practice Address - Zip Code:66439
Practice Address - Country:US
Practice Address - Phone:785-879-4325
Practice Address - Fax:785-879-4398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAH ACQUISITION COMPANY 3 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH007002261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200575150BMedicaid
KS110054OtherBLUE SHIELD
KS110054OtherBLUE SHIELD