1295792869 NPI number — COUNTY OF STANTON

Table of content: (NPI 1295792869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295792869 NPI number — COUNTY OF STANTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF STANTON
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:
STANTON 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:
1295792869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 572
Provider Second Line Business Mailing Address:
101 S. FRONTAGE ROAD
Provider Business Mailing Address City Name:
JOHNSON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67855-0572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-492-6879
Provider Business Mailing Address Fax Number:
620-492-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S FRONTAGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67855-0572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-492-6879
Provider Business Practice Location Address Fax Number:
620-492-1445
Provider Enumeration Date:
04/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
620-492-6879

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1860 , 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: 100097820BKS , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112009 . This is a "BLUE CROSS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 100097820B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".