Basic Information
| Provider Information | |||||||||
| NPI: | 1588653588 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COWLEY COUNTY MENTAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22214 D ST | ||||||||
| Address2: | STROTHER FIELD | ||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671567376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204424540 | ||||||||
| FaxNumber: | 6204424559 | ||||||||
| Practice Location | |||||||||
| Address1: | 22214 D ST | ||||||||
| Address2: | STROTHER FIELD | ||||||||
| City: | WINFIELD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671567376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6204424540 | ||||||||
| FaxNumber: | 6204424559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 05/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | ALFORD | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6204424540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 005 | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 006903 | 01 | KS | BCBS NUMBER | OTHER | 100098100C | 05 | KS | MEDICAID | 100098100D | 05 | KS | MEDICAID | 100098100A | 05 | KS | MEDICAID | 100098100E | 05 | KS | MEDICAID | 100363510A | 05 | KS | MEDICAID |