Provider Demographics
NPI:1407811227
Name:COUNTY OF LANE
Entity Type:Organization
Organization Name:COUNTY OF LANE
Other - Org Name:LANE COUNTY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-397-5321
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:KS
Mailing Address - Zip Code:67839-0488
Mailing Address - Country:US
Mailing Address - Phone:620-397-5316
Mailing Address - Fax:620-397-2264
Practice Address - Street 1:444 WEST LONG ST.
Practice Address - Street 2:
Practice Address - City:DIGHTON
Practice Address - State:KS
Practice Address - Zip Code:67839-0488
Practice Address - Country:US
Practice Address - Phone:620-397-5316
Practice Address - Fax:620-397-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH051001261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016536OtherBCBS
KS100098890DMedicaid
KS173475Medicare Oscar/Certification