Provider Demographics
NPI:1164429148
Name:COUNTY OF CLAY
Entity Type:Organization
Organization Name:COUNTY OF CLAY
Other - Org Name:CLAY COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY HEALTH ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-632-3193
Mailing Address - Street 1:820 SPELLMAN CIR
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-7492
Mailing Address - Country:US
Mailing Address - Phone:785-632-3193
Mailing Address - Fax:785-632-5849
Practice Address - Street 1:820 SPELLMAN CIR
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-7492
Practice Address - Country:US
Practice Address - Phone:785-632-3193
Practice Address - Fax:785-632-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100115070AMedicaid
KS12724OtherBLUECROSS/BLUESHIELD KS
KS642610OtherFIRSTGUARD/HEALTH WAVE
KSUNICAREOtherHEALTHWAVE
KS100115070DMedicaid
KS460005OtherHEALTHWAVE
KS100115070AMedicaid