Basic Information
| Provider Information | |||||||||
| NPI: | 1972794402 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS/COLUMBUS CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667622546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
| FaxNumber: | 6202312808 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 W SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667251276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202492101 | ||||||||
| FaxNumber: | 6204292106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 01/03/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | POSTAI | ||||||||
| AuthorizedOfficialFirstName: | KRISTA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6202319873 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 468481 | 01 | CHILDRENS MERCY FHP | OTHER | 17-1821 | 01 | NGS NAT. GOV. SERVICES | OTHER | 100456320E | 05 | KS | MEDICAID | 200099190C | 05 | OK | MEDICAID | 100456320W | 05 | KS | MEDICAID |