Provider Demographics
NPI:1124192901
Name:COUNTY OF CLAY
Entity Type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:CLAY COUNTY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CHAREST
Authorized Official - Suffix:
Authorized Official - Credentials:EMTI
Authorized Official - Phone:785-632-2166
Mailing Address - Street 1:603 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432
Mailing Address - Country:US
Mailing Address - Phone:785-632-2166
Mailing Address - Fax:785-632-6050
Practice Address - Street 1:603 4TH ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432
Practice Address - Country:US
Practice Address - Phone:785-632-2166
Practice Address - Fax:785-632-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS350341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
005656OtherBCBS
KS100115070CMedicaid
KS100115070CMedicaid