NPIMap

Organization Active NPI

Montgomery County Community Clinic, Inc

  • Primary Care Clinic/Center
  • Independence, KS
National Provider Identifier
1285896993
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
NONE REQUIRED Issued in KS
Legal business name
MONTGOMERY COUNTY COMMUNITY CLINIC, INC
Practice address
900 W Myrtle St
Suite 105
Independence, KS 67301-3242
Phone
(620) 331-8190
Fax
(620) 652-4143
NPI assigned
Jun 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. Susan V.M. Kleinbeck, RN, PHD
Title
Executive Director
Phone
(620) 331-8190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NONE REQUIRED KS Primary

Addresses

Primary practice location

900 W Myrtle St
Suite 105
Independence, KS 67301-3242

Mailing address

PO Box 612
Independence, KS 67301-0612
Phone (620) 331-8190

Other names 1

  • First Presbyterian Church dba Montgomery County Community Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

900 W Myrtle St
Ste 105
Independence, KS 67301
Phone (620) 331-8190

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1285896993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 612",
            "city": "INDEPENDENCE",
            "state": "KS",
            "postal_code": "673010612",
            "telephone_number": "620-331-8190",
            "fax_number": "620-652-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W MYRTLE ST",
            "address_2": "SUITE 105",
            "city": "INDEPENDENCE",
            "state": "KS",
            "postal_code": "673013242",
            "telephone_number": "620-331-8190",
            "fax_number": "620-652-4143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY COUNTY COMMUNITY CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "KLEINBECK",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "V.M.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "620-331-8190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "RN, PHD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KS",
            "license": "NONE REQUIRED",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Presbyterian Church dba Montgomery County Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Independence, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.