Provider Demographics
NPI:1699747279
Name:COMMUNITY HEALTHCARE SYSTEM, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTHCARE SYSTEM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-889-5002
Mailing Address - Street 1:606 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:KS
Mailing Address - Zip Code:66415-9637
Mailing Address - Country:US
Mailing Address - Phone:785-857-3334
Mailing Address - Fax:785-857-3349
Practice Address - Street 1:606 1ST ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:KS
Practice Address - Zip Code:66415-9637
Practice Address - Country:US
Practice Address - Phone:785-857-3334
Practice Address - Fax:785-857-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH075001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001436OtherBLUE CROSS BLUE SHIELD
KS100319940AMedicaid
KS173483Medicare Oscar/Certification