Provider Demographics
NPI:1033105358
Name:COUNTY OF DECATUR
Entity Type:Organization
Organization Name:COUNTY OF DECATUR
Other - Org Name:DECATUR COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-475-8118
Mailing Address - Street 1:902 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-2412
Mailing Address - Country:US
Mailing Address - Phone:785-475-8118
Mailing Address - Fax:785-475-8143
Practice Address - Street 1:902 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2412
Practice Address - Country:US
Practice Address - Phone:785-475-8118
Practice Address - Fax:785-475-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089260Medicaid
KS012748OtherBLUE CROSS BLUE SHIELD