Provider Demographics
NPI:1891710703
Name:COMANCHE COUNTY HOSPITAL
Entity Type:Organization
Organization Name:COMANCHE COUNTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-582-2144
Mailing Address - Street 1:301 S WASHINGTON
Mailing Address - Street 2:COMANCHE COUNTY MEDICAL CLINIC
Mailing Address - City:COLDWATER
Mailing Address - State:KS
Mailing Address - Zip Code:67029
Mailing Address - Country:US
Mailing Address - Phone:620-582-2136
Mailing Address - Fax:620-582-2515
Practice Address - Street 1:301 S WASHINTON
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:KS
Practice Address - Zip Code:67029
Practice Address - Country:US
Practice Address - Phone:620-582-2136
Practice Address - Fax:620-582-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100004340NMedicaid
KS100004340NMedicaid