Provider Demographics
NPI:1003209719
Name:ROOKS COUNTY HEALTH CENTER
Entity type:Organization
Organization Name:ROOKS COUNTY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAN DYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-688-3695
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67663-0389
Mailing Address - Country:US
Mailing Address - Phone:785-434-2622
Mailing Address - Fax:785-434-2434
Practice Address - Street 1:1210 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:KS
Practice Address - Zip Code:67663-1632
Practice Address - Country:US
Practice Address - Phone:785-434-4553
Practice Address - Fax:785-434-2434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROOKS COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-05
Last Update Date:2025-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-082-001207X00000X, 208800000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099310FMedicaid
KS100099310FMedicaid