Basic Information
| Provider Information | |||||||||
| NPI: | 1770834244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLATHE COMMUNITY CLINIC INC | ||||||||
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| OtherOrganizationName: | RIVER VALLEY FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 529 | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814250529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703236141 | ||||||||
| FaxNumber: | 8552998071 | ||||||||
| Practice Location | |||||||||
| Address1: | 308 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703236141 | ||||||||
| FaxNumber: | 8552998071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2012 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOTSENPILLER | ||||||||
| AuthorizedOfficialFirstName: | KAYE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9703236141 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 061930 | 01 | CO | MEDICARE A PTAN | OTHER | 617703000 | 01 | CO | DEPT OF LABOR, OLATHE ONLY | OTHER | 619803300 | 01 | CO | DEPT OF LABOR, MONTROSE ONLY | OTHER | 294943 | 01 | CO | MEDICARE B PTAN | OTHER | DU5283 | 01 | CO | RAILROAD WORKERS MEDICARE | OTHER | OLATHE ONLY: 9890527 | 05 | CO | MEDICAID |