Provider Demographics
NPI:1215907951
Name:WEST CENTRAL KANSAS ASSOCIATION, INC
Entity type:Organization
Organization Name:WEST CENTRAL KANSAS ASSOCIATION, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-483-0708
Mailing Address - Street 1:200 S MAIN ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2920
Mailing Address - Country:US
Mailing Address - Phone:785-483-3131
Mailing Address - Fax:785-483-4859
Practice Address - Street 1:222 S KANSAS ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-3000
Practice Address - Country:US
Practice Address - Phone:785-483-3131
Practice Address - Fax:785-483-4859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CENTRAL KANSAS ASSOCIATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-25
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171350A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100306710BMedicaid
KS110498OtherBCBS
KS178504Medicare Oscar/Certification
KS110498Medicare ID - Type UnspecifiedMEDICARE PART B