1164429148 NPI number — COUNTY OF CLAY

Table of content: (NPI 1164429148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164429148 NPI number — COUNTY OF CLAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CLAY
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:
CLAY 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:
1164429148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 SPELLMAN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAY CENTER
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67432-7492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-632-3193
Provider Business Mailing Address Fax Number:
785-632-5849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 SPELLMAN CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-7492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-632-3193
Provider Business Practice Location Address Fax Number:
785-632-5849
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RICKLEY
Authorized Official First Name:
DANA
Authorized Official Middle Name:
Authorized Official Title or Position:
COUNTY HEALTH ADMINISTRATOR
Authorized Official Telephone Number:
785-632-3193

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100115070A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12724 . This is a "BLUECROSS/BLUESHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 642610 . This is a "FIRSTGUARD/HEALTH WAVE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: UNICARE . This is a "HEALTHWAVE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100115070D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 460005 . This is a "HEALTHWAVE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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