Provider Demographics
NPI:1003953977
Name:UNIFIED GOVERNMENT OF WYANDOTTE COUNTY/KANSAS CITY, KANSAS
Entity Type:Organization
Organization Name:UNIFIED GOVERNMENT OF WYANDOTTE COUNTY/KANSAS CITY, KANSAS
Other - Org Name:WYANDOTTE-LEAVENWORTH AAA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-442-4811
Mailing Address - Street 1:1300 N 78TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2406
Mailing Address - Country:US
Mailing Address - Phone:913-328-4531
Mailing Address - Fax:
Practice Address - Street 1:1300 N 78TH ST STE 100
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2406
Practice Address - Country:US
Practice Address - Phone:913-328-4531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100304530AMedicaid