Provider Demographics
NPI:1497800684
Name:COUNTY OF COWLEY
Entity Type:Organization
Organization Name:COUNTY OF COWLEY
Other - Org Name:CITY-COWLEY COUNTY HEALTH DEPT..
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAZIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-221-1430
Mailing Address - Street 1:320 E 9TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2871
Mailing Address - Country:US
Mailing Address - Phone:620-221-1430
Mailing Address - Fax:620-221-0389
Practice Address - Street 1:320 E 9TH AVE STE B
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2871
Practice Address - Country:US
Practice Address - Phone:620-221-1430
Practice Address - Fax:620-221-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100115150AMedicaid
KS=========OtherTAX ID
KS=========OtherTAX ID