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Organization
COFFEYVILLE REGIONAL MEDICAL CENTER INC
Active
Organization
COFFEYVILLE REGIONAL MEDICAL CENTER INC
Active
Parent organization
COFFEYVILLE REGIONAL MEDICAL CENTER, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COFFEYVILLE REGIONAL MEDICAL CENTER, INC
Authorized official
MR. BRIAN LAWRENCE (CEO)
(620) 251-1200
Entity
Organization
Contact information
Practice address
1400 W 4TH STREET, COFFEYVILLE, KS 67337
(620) 251-1200
(620) 252-1562
Mailing address
1400 W 4TH STREET, COFFEYVILLE, KS 67337-3306
(620) 251-1200
(620) 252-1562
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
NULL
207L00000X
Anesthesiology Physician
Primary
—
—
207P00000X
Emergency Medicine Physician
—
NULL
207P00000X
Emergency Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107200C
—
KS
05
—
100695360D
—
OK
01
—
110385
KS BCBS ER PROVIDER GROUP
KS
Enumeration date
03/26/2007
Last updated
03/17/2023
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