Provider Demographics
NPI:1295749067
Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Entity type:Organization
Organization Name:COMMUNITY MEMORIAL HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANDOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-562-2311
Mailing Address - Street 1:1902 MAY ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1200
Mailing Address - Country:US
Mailing Address - Phone:785-562-3942
Mailing Address - Fax:785-562-5149
Practice Address - Street 1:1902 MAY ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1200
Practice Address - Country:US
Practice Address - Phone:785-562-3942
Practice Address - Fax:785-562-5149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MEMORIAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCE9160OtherRAILROAD MEDICARE
KS10005390GMedicaid
KS016863OtherBLUE CROSS/BLUE SHIELD KS
KSCE9160OtherRAILROAD MEDICARE
KS10005390GMedicaid