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445 Hilltop Street Elkhart KS 67950 | |
| (620) 697-2141 | |
| (620) 697-4766 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 445 Hilltop Street, Elkhart, Kansas |
| Authorized Official Name and Position | Patrick Custer (CEO) |
| Authorized Official Contact | 6206972141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 937 Elkhart KS 67950-0937 Ph: (620) 697-2141 | 445 Hilltop Street Elkhart KS 67950 Ph: (620) 697-2141 |
| NPI Number | 1518995034 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 10/27/2022 |
| Certification Date | 10/27/2022 |
| Medicare PECOS PAC ID | 5395644637 |
|---|---|
| Medicare Enrollment ID | O20070202000081 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518995034 | NPI | - | NPPES |
| 000190 | Other | KS | BCBS |
| 100087540A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | H065001 (Kansas) | Primary |