Provider Demographics
NPI:1427081041
Name:LINDSBORG COMMUNITY RURAL HEALTH CLINIC INC
Entity type:Organization
Organization Name:LINDSBORG COMMUNITY RURAL HEALTH CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN DER WEGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-227-3308
Mailing Address - Street 1:601 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-2328
Mailing Address - Country:US
Mailing Address - Phone:785-227-3371
Mailing Address - Fax:
Practice Address - Street 1:601 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:LINDSBORG
Practice Address - State:KS
Practice Address - Zip Code:67456-2328
Practice Address - Country:US
Practice Address - Phone:785-227-3371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
173884Medicare Oscar/Certification
016770Medicare PIN