Provider Demographics
NPI:1275528762
Name:PHILLIPS COUNTY
Entity Type:Organization
Organization Name:PHILLIPS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/HEALTH OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LOUETTA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:FORELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-543-6850
Mailing Address - Street 1:784 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-1939
Mailing Address - Country:US
Mailing Address - Phone:785-543-6850
Mailing Address - Fax:785-543-6852
Practice Address - Street 1:784 6TH ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1939
Practice Address - Country:US
Practice Address - Phone:785-543-6850
Practice Address - Fax:785-543-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100011960AMedicaid
KS100092360AMedicaid
KS629780OtherFIRST GUARD PROVIDER NUMBER
KS000525OtherBLUE SHIELD HOME HEALTH
KS012764OtherBLUE SHIELD PROVIDER NUMBER
KS100092360BMedicaid
KS012764OtherBLUE SHIELD PROVIDER NUMBER