Provider Demographics
NPI:1528120847
Name:SOUTHEAST KANSAS HEALTH CARE LLC
Entity type:Organization
Organization Name:SOUTHEAST KANSAS HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGGIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLEX
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:620-251-2400
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0943
Mailing Address - Country:US
Mailing Address - Phone:620-251-2400
Mailing Address - Fax:620-251-1619
Practice Address - Street 1:1411 W 4TH ST BLDG C
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3350
Practice Address - Country:US
Practice Address - Phone:620-251-2400
Practice Address - Fax:620-251-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS46360Medicare UPIN
KSB68853Medicare UPIN