Provider Demographics
NPI:1093792046
Name:COUNTY OF JOHNSON
Entity Type:Organization
Organization Name:COUNTY OF JOHNSON
Other - Org Name:JOHNSON COUNTY MED-ACT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEB
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-715-1974
Mailing Address - Street 1:11811 S SUNSET DR
Mailing Address - Street 2:STE. 1100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2793
Mailing Address - Country:US
Mailing Address - Phone:913-715-1950
Mailing Address - Fax:913-715-1959
Practice Address - Street 1:11811 S SUNSET DR
Practice Address - Street 2:STE. 1100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7055
Practice Address - Country:US
Practice Address - Phone:913-715-1950
Practice Address - Fax:913-715-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04506013OtherBCBS
MO04506013OtherBCBS
KS100091530BMedicaid
KS100091530BMedicaid
KS590006973Medicare PIN