1063415172 NPI number — CITY OF EMPORIA

Table of content: (NPI 1063415172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063415172 NPI number — CITY OF EMPORIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF EMPORIA
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:
LYON COUNTY AMBULANCE SERVICE
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:
1063415172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 928
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66801-0928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-343-4232
Provider Business Mailing Address Fax Number:
620-341-4395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66801-3918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-343-4232
Provider Business Practice Location Address Fax Number:
620-341-4395
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
SERVICE DIRECTOR
Authorized Official Telephone Number:
620-343-4235

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  1130 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5880 . This is a "BLUE CROSS/BLUE SHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 590077784 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100092330A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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