NPIMap

Organization Active NPI

Community Memorial Healthcare, Inc.

Doing business as Marysville Clinic

  • Rural Health Clinic/Center
  • Marysville, KS
National Provider Identifier
1124049937
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY MEMORIAL HEALTHCARE, INC.
Doing business as
Marysville Clinic
Practice address
808 N 19TH St
Marysville, KS 66508-1358
Phone
(785) 562-2303
Fax
(785) 562-2034
NPI assigned
Jul 21, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY MEMORIAL HEALTHCARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Therese M Landoll
Title
Cfo
Phone
(785) 562-2311

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

808 N 19TH St
Marysville, KS 66508-1358

Mailing address

808 N 19TH St
Marysville, KS 66508-1358
Phone (785) 562-2303

Other names 1

  • Marysville Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304000181 KS Part B Supplier - Clinic/Group Practice 6608763503 Receives reassigned benefits from 14 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marysville, KS; Axtell, KS; Blue Rapids, KS

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Community Memorial HLTH Inc

Locations

808 N 19th St
Marysville, KS 66508
Phone (785) 562-2303

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1124049937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 N 19TH ST",
            "city": "MARYSVILLE",
            "state": "KS",
            "postal_code": "665081358",
            "telephone_number": "785-562-2303",
            "fax_number": "785-562-2034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 N 19TH ST",
            "city": "MARYSVILLE",
            "state": "KS",
            "postal_code": "665081358",
            "telephone_number": "785-562-2303",
            "fax_number": "785-562-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY MEMORIAL HEALTHCARE, INC",
        "enumeration_date": "2006-07-21",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LANDOLL",
        "authorized_official_first_name": "THERESE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "785-562-2311"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marysville Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marysville, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.