1760524219 NPI number — COUNTY OF RICE

Table of content: (NPI 1760524219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760524219 NPI number — COUNTY OF RICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF RICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RICE COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760524219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 535
Provider Second Line Business Mailing Address:
1432 W. COMMERCIAL
Provider Business Mailing Address City Name:
LYONS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67554-0535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-257-2171
Provider Business Mailing Address Fax Number:
620-257-7856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1432 W COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYONS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67554-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-257-2171
Provider Business Practice Location Address Fax Number:
620-257-7856
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DETMER
Authorized Official First Name:
MARCI
Authorized Official Middle Name:
Authorized Official Title or Position:
RN,BSN
Authorized Official Telephone Number:
620-257-2171

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012765 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100091510A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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