Provider Demographics
NPI:1952416026
Name:COMMUNITY WELLNESS CENTER
Entity Type:Organization
Organization Name:COMMUNITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-263-0776
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0848
Mailing Address - Country:US
Mailing Address - Phone:620-855-4616
Mailing Address - Fax:620-855-4613
Practice Address - Street 1:107 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0848
Practice Address - Country:US
Practice Address - Phone:620-855-4616
Practice Address - Fax:620-855-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171000Medicare ID - Type UnspecifiedMEDICARE GROUP ID