Provider Demographics
NPI:1316010317
Name:GREELEY COUNTY HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:GREELEY COUNTY HEALTH SERVICES, INC
Other - Org Name:WALLACE COUNTY FAMILY PRACTICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-376-4251
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:SHARON SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:67758-0310
Mailing Address - Country:US
Mailing Address - Phone:785-852-4230
Mailing Address - Fax:785-852-4364
Practice Address - Street 1:104 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SHARON SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:67758-9999
Practice Address - Country:US
Practice Address - Phone:785-852-4230
Practice Address - Fax:785-852-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200383210 BMedicaid
KS111213Medicare ID - Type UnspecifiedCLINIC
KS5644490001Medicare NSC