Provider Demographics
NPI:1215643143
Name:COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:CREITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-240-5015
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-1832
Mailing Address - Country:US
Mailing Address - Phone:888-777-9170
Mailing Address - Fax:620-231-5062
Practice Address - Street 1:203 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-2527
Practice Address - Country:US
Practice Address - Phone:888-777-9170
Practice Address - Fax:620-231-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)