Provider Demographics
NPI:1376545384
Name:COUNTY OF ELLIS
Entity Type:Organization
Organization Name:COUNTY OF ELLIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-628-9440
Mailing Address - Street 1:2507 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2233
Mailing Address - Country:US
Mailing Address - Phone:785-628-9440
Mailing Address - Fax:785-628-0804
Practice Address - Street 1:2507 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2233
Practice Address - Country:US
Practice Address - Phone:785-628-9440
Practice Address - Fax:785-628-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100113480AMedicaid
KS012726OtherBLUE CROSS/BLUE SHIELD
KS629630OtherFIRSTGUARD
KS012726Medicare ID - Type UnspecifiedPUBLIC HEALTH