Provider Demographics
NPI:1477506434
Name:COUNTY OF WILSON
Entity Type:Organization
Organization Name:COUNTY OF WILSON
Other - Org Name:WILSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-378-4455
Mailing Address - Street 1:421 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1342
Mailing Address - Country:US
Mailing Address - Phone:620-378-4455
Mailing Address - Fax:620-378-4647
Practice Address - Street 1:421 N 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1342
Practice Address - Country:US
Practice Address - Phone:620-378-4455
Practice Address - Fax:620-378-4647
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILSON COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11550OtherPREFERRED HEALTH PROVIDER
KS12769OtherBC&BS PROVIDER NUMBER
KS460089OtherCHILDRENS MERCY
KS113011Medicare PIN