Provider Demographics
NPI:1407899685
Name:COUNTY OF ELLSWORTH
Entity Type:Organization
Organization Name:COUNTY OF ELLSWORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:785-472-3454
Mailing Address - Street 1:1107 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-2553
Mailing Address - Country:US
Mailing Address - Phone:785-472-3454
Mailing Address - Fax:785-472-3644
Practice Address - Street 1:1107 EVANS ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-2553
Practice Address - Country:US
Practice Address - Phone:785-472-3454
Practice Address - Fax:785-472-3644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLSWORTH COUNTY EMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-14
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS570146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100092210CMedicaid
KS100092210CMedicaid