Provider Demographics
NPI:1245217637
Name:SEDGWICK COUNTY
Entity Type:Organization
Organization Name:SEDGWICK COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCAS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT PARAMEDIC
Authorized Official - Phone:970-474-3313
Mailing Address - Street 1:315 CEDAR ST
Mailing Address - Street 2:PO BOX 87
Mailing Address - City:JULESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80737-1532
Mailing Address - Country:US
Mailing Address - Phone:970-474-3313
Mailing Address - Fax:970-474-9885
Practice Address - Street 1:315 CEDAR ST
Practice Address - Street 2:
Practice Address - City:JULESBURG
Practice Address - State:CO
Practice Address - Zip Code:80737-1532
Practice Address - Country:US
Practice Address - Phone:970-474-3313
Practice Address - Fax:970-474-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35919OtherBLUE CROSS BLUE SHIELD
CO06638035Medicaid
CO06638035Medicaid
NE=========00Medicaid