1558364752 NPI number — COUNTY OF ELLSWORTH

Table of content: (NPI 1558364752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558364752 NPI number — COUNTY OF ELLSWORTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF ELLSWORTH
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:
ELLSWORTH 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:
1558364752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1603 N AYLWARD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67439-2541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-472-4488
Provider Business Mailing Address Fax Number:
785-472-4489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1603 N AYLWARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67439-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-472-4488
Provider Business Practice Location Address Fax Number:
785-472-4489
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BUEHLER
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
785-472-4488

Provider Taxonomy Codes

  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100092210A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 012758 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 600000842 . This is a "MEDICARE RR PALMETTO" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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