Organization
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL SPENCER CREITZ (SENIOR VICE PRESIDENT)
(620) 240-5015
Entity
Organization
Contact information
Practice address
924 N BROADWAY ST, PITTSBURG, KS 66762-3910
(620) 670-8070
Mailing address
PO BOX 1832, PITTSBURG, KS 66762-1832
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171851
MEDICARE
KS
05
—
200099190A
—
OK
05
—
30003958250013
—
KS
Enumeration date
08/11/2005
Last updated
07/22/2024
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