Provider Demographics
NPI:1629069844
Name:WICHITA COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:WICHITA COUNTY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-375-2233
Mailing Address - Street 1:RR 2 BOX 38
Mailing Address - Street 2:211 EAST EARL ST
Mailing Address - City:LEOTI
Mailing Address - State:KS
Mailing Address - Zip Code:67861-9504
Mailing Address - Country:US
Mailing Address - Phone:620-375-4600
Mailing Address - Fax:
Practice Address - Street 1:211 E EARL ST
Practice Address - Street 2:
Practice Address - City:LEOTI
Practice Address - State:KS
Practice Address - Zip Code:67861-9620
Practice Address - Country:US
Practice Address - Phone:620-375-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH102001313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107220AMedicaid