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Organization

COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DANIEL SPENCER CREITZ JD (SENIOR VP, CHIEF COMPLIANCE OFFICER)
(620) 240-5015
Entity
Organization

Contact information

Practice address
2322 S MAIN ST, FORT SCOTT, KS 66701-3026
(620) 223-8040
Mailing address
PO BOX 1832, PITTSBURG, KS 66762-1832

Taxonomy

Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30003958250054
KS
01
KDADS033021H
SUBSTANCE USE AND ADDICTIONS SERVICES CERTIFICATE
KS
Enumeration date
04/30/2021
Last updated
12/30/2024
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