Provider Demographics
NPI:1710107453
Name:COLBY COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:COLBY COMMUNITY COLLEGE
Other - Org Name:STUDENT HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR OF STUDENT HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:BREWSTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-460-5502
Mailing Address - Street 1:1255 SO RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701
Mailing Address - Country:US
Mailing Address - Phone:785-460-5502
Mailing Address - Fax:785-460-4691
Practice Address - Street 1:1255 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701
Practice Address - Country:US
Practice Address - Phone:785-460-5502
Practice Address - Fax:785-460-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health