Provider Demographics
NPI:1003812736
Name:COUNTY OF RILEY
Entity Type:Organization
Organization Name:COUNTY OF RILEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MS RN
Authorized Official - Phone:785-776-4779
Mailing Address - Street 1:2030 TECUMSEH RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3541
Mailing Address - Country:US
Mailing Address - Phone:785-776-4779
Mailing Address - Fax:785-565-6565
Practice Address - Street 1:2030 TECUMSEH RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3512
Practice Address - Country:US
Practice Address - Phone:785-776-4779
Practice Address - Fax:785-565-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097780AMedicaid
KS012719Medicare PIN