Provider Demographics
NPI:1487939773
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-231-9873
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:620-231-9873
Mailing Address - Fax:620-231-2808
Practice Address - Street 1:102 S CLINE
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3022
Practice Address - Country:US
Practice Address - Phone:620-252-6989
Practice Address - Fax:620-251-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100456330CMedicaid
OK200099190FMedicaid
OK200099190FMedicaid