Provider Demographics
NPI:1962410241
Name:CITIZENS MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:CITIZENS MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-460-4801
Mailing Address - Street 1:1625 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3722
Mailing Address - Country:US
Mailing Address - Phone:785-462-8295
Mailing Address - Fax:785-460-1435
Practice Address - Street 1:1625 S. FRANKLIN AVENUE, CITIZENS MEDICAL CENTER, INC.
Practice Address - Street 2:DBA CITIZENS MEDICAL CENTER LTCU,
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701
Practice Address - Country:US
Practice Address - Phone:785-462-8295
Practice Address - Fax:785-460-1435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITIZENS MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-03
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS310400000X, 313M00000X
KSH097101313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100110250AMedicaid