Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 1408 East St, Iola, Kansas |
Authorized Official Name and Position | Martha Elaine O'connor (ADMINISTRATOR) |
Authorized Official Contact | 6203653115 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1408 East Street Iola KS 66749-3004 Ph: (620) 365-3115 | 1408 East St Iola KS 66749-4402 Ph: (620) 365-3115 |
NPI Number | 1851325773 |
---|---|
Provider Enumeration Date | 07/10/2006 |
Last Update Date | 10/04/2024 |
Medicare PECOS PAC ID | 9436069267 |
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Medicare Enrollment ID | O20030430000031 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851325773 | NPI | - | NPPES |
100215590B | Medicaid | KS | |
1550 | Other | KS | BLUE CROSS RHC |
178969 | Other | KS | RURAL HEALTH IDENTIFICATION |
17D0450573 | Other | CLIA WAIVER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 178969 (Kansas) | Primary |
Community Health Center Of Southeast Kansas, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 203 N Kentucky St, Iola, KS 66749 Phone: 888-777-9170 Fax: 620-231-5062 | |
Community Health Center Of Southeast Kansas, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2051 N State St, Iola, KS 66749 Phone: 620-380-6600 Fax: 620-380-6215 |