NPIMap

Organization Active NPI

Community Health Center of Southeast Kansas, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fort Scott, KS
National Provider Identifier
1003499708
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.
Practice address
2322 S Main St
Fort Scott, KS 66701-3026
Phone
(620) 223-8040
NPI assigned
Apr 30, 2021
Last updated
Dec 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Spencer Creitz, JD
Title
Senior VP, Chief Compliance Officer
Phone
(620) 240-5015

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

2322 S Main St
Fort Scott, KS 66701-3026

Mailing address

PO Box 1832
Pittsburg, KS 66762-1832

Other identifiers 2

IdentifierTypeStateIssuer
30003958250054MedicaidKS
KDADS033021HOtherKSSUBSTANCE USE AND ADDICTIONS SERVICES CERTIFICATE

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center Inc43 organizations share this tax ID, including this one

Other organizations with this tax ID 42

Organizations that report the same tax identification number in the National Provider Directory.

View all 42

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1003499708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1832",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667621832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2322 S MAIN ST",
            "city": "FORT SCOTT",
            "state": "KS",
            "postal_code": "667013026",
            "telephone_number": "620-223-8040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF SOUTHEAST KANSAS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "CREITZ",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SPENCER",
        "authorized_official_title_or_position": "SENIOR VP, CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "620-240-5015",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30003958250054",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE USE AND ADDICTIONS SERVICES CERTIFICATE",
            "identifier": "KDADS033021H",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Scott, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.