Provider Demographics
NPI:1871823344
Name:CAH ACQUISITION COMPANY 2 LLC
Entity Type:Organization
Organization Name:CAH ACQUISITION COMPANY 2 LLC
Other - Org Name:OSWEGO COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-795-2921
Mailing Address - Street 1:800 BARKER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSWEGO
Mailing Address - State:KS
Mailing Address - Zip Code:67356-9033
Mailing Address - Country:US
Mailing Address - Phone:620-795-2119
Mailing Address - Fax:620-795-2357
Practice Address - Street 1:800 BARKER DR STE B
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:KS
Practice Address - Zip Code:67356
Practice Address - Country:US
Practice Address - Phone:620-795-2119
Practice Address - Fax:620-795-2357
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAH ACQUISITION COMPANY 2 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-06
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH050003261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200570210CMedicaid
KS178561Medicare Oscar/Certification