NPIMap

Organization Active NPI

Coffeyville Regional Medical Center Inc

  • Ambulance
  • Coffeyville, KS
National Provider Identifier
1124177191
Registry record updated Mar 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
License
400 Issued in KS
Legal business name
COFFEYVILLE REGIONAL MEDICAL CENTER INC
Practice address
1400 W 4TH Street
Coffeyville, KS 67337
Phone
(620) 251-1200
Fax
(620) 252-1562
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2023

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

Authorized official

Name
Brian Lawrence
Title
Ceo
Phone
(620) 251-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X 400 KS Primary

Addresses

Primary practice location

1400 W 4TH Street
Coffeyville, KS 67337

Mailing address

1400 W 4TH Street
Coffeyville, KS 67337-3306
Phone (620) 251-1200

Other identifiers 3

IdentifierTypeStateIssuer
100695360BMedicaidOK
005571OtherKSBCBS
100107200GMedicaidKS

National Provider Directory

National Provider Directory
Tax ID family
Coffeyville Regional Me4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1124177191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 W 4TH STREET",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673373306",
            "telephone_number": "620-251-1200",
            "fax_number": "620-252-1562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 W 4TH STREET",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "67337",
            "telephone_number": "620-251-1200",
            "fax_number": "620-252-1562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEYVILLE REGIONAL MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "LAWRENCE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "620-251-1200"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "KS",
            "license": "400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100695360B",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "005571",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100107200G",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coffeyville, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.