# COFFEYVILLE REGIONAL MEDICAL CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COFFEYVILLE REGIONAL MEDICAL CENTER, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1265550891
- **Legal business name:** COFFEYVILLE REGIONAL MEDICAL CENTER, INC
- **Authorized official:** MR. BRIAN LAWRENCE (CEO)
- **Authorized official phone:** (620) 251-1200

## Contact information

- **Practice address:** 1400 W 4TH STREET, COFFEYVILLE, KS 67337
- **Practice address phone:** (620) 251-1200
- **Practice address fax:** (620) 252-1562
- **Mailing address:** 1400 W 4TH STREET, COFFEYVILLE, KS 67337-3306
- **Mailing address phone:** (620) 251-1200
- **Mailing address fax:** (620) 252-1562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 03/26/2007
- **Last updated:** 03/17/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100107200C | — | KS |
| 05 | — | 100695360D | — | OK |
| 01 | — | 110385 | KS BCBS ER PROVIDER GROUP | KS |