Provider Demographics
NPI:1770834244
Name:OLATHE COMMUNITY CLINIC INC
Entity Type:Organization
Organization Name:OLATHE COMMUNITY CLINIC INC
Other - Org Name:RIVER VALLEY FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTSENPILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-323-6141
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-0529
Mailing Address - Country:US
Mailing Address - Phone:970-323-6141
Mailing Address - Fax:855-299-8071
Practice Address - Street 1:308 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425
Practice Address - Country:US
Practice Address - Phone:970-323-6141
Practice Address - Fax:855-299-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO061930OtherMEDICARE A PTAN
CO617703000OtherDEPT OF LABOR, OLATHE ONLY
CO619803300OtherDEPT OF LABOR, MONTROSE ONLY
CO294943OtherMEDICARE B PTAN
CODU5283OtherRAILROAD WORKERS MEDICARE
COOLATHE ONLY: 9890527Medicaid