1245217637 NPI number — SEDGWICK COUNTY

Table of content: (NPI 1245217637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245217637 NPI number — SEDGWICK COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEDGWICK COUNTY
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:
1245217637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10802 FARNAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68154-3237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-218-4392
Provider Business Mailing Address Fax Number:
877-343-0131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JULESBURG
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80737-1532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-474-3313
Provider Business Practice Location Address Fax Number:
970-474-9885
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
TASHA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
531-895-5853

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590042202 . This is a "PALMETTO GBA" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 846000801 . This is a "TRICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 06638035 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35919 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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