1023039203 NPI number — GEARY COUNTY INFANT TODDLER SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023039203 NPI number — GEARY COUNTY INFANT TODDLER SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEARY COUNTY INFANT TODDLER SERVICES
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:
Provider Other Organization Name Type Code:
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:
1023039203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/28/2008
NPI Reactivation Date:
11/30/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIRARD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66743-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-654-8701
Provider Business Mailing Address Fax Number:
620-724-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
814 CAROLINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNCTION CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66441-5210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-762-7859
Provider Business Practice Location Address Fax Number:
785-762-2144
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIEHL
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
785-762-7859

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100211800B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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