| Cristo Rey Healthcare, Llc | |
| 
					907a E Jesuit Ln St Marys KS 66536-9605  | |
| (785) 437-3711 | |
| (785) 437-6711 | 
| Full Name | Cristo Rey Healthcare, Llc | 
|---|---|
| Speciality | Family Medicine | 
| Location | 907a E Jesuit Ln, St Marys, Kansas | 
| Authorized Official Name and Position | Carl Bruce Carroll (PHYSICIAN) | 
| Authorized Official Contact | 7854373711 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Cristo Rey Healthcare, Llc 907a E Jesuit Ln St Marys KS 66536-9605 Ph: (785) 437-3711  | Cristo Rey Healthcare, Llc 907a E Jesuit Ln St Marys KS 66536-9605 Ph: (785) 437-3711  | 
| NPI Number | 1205802279 | 
|---|---|
| Provider Enumeration Date | 02/28/2006 | 
| Last Update Date | 08/22/2020 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1205802279 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Q00000X | Family Medicine | 04-23089 (Kansas) | Primary | 
Community Healthcare System, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 206 Grand Ave, St Marys, KS 66536 Phone: 785-437-3734 Fax: 785-437-6186  |