Provider Demographics
NPI:1669441523
Name:COUNTY OF GRANT
Entity Type:Organization
Organization Name:COUNTY OF GRANT
Other - Org Name:GRANT COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GRANT CO EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-ID
Authorized Official - Phone:620-356-3400
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-0514
Mailing Address - Country:US
Mailing Address - Phone:620-356-3400
Mailing Address - Fax:620-356-4512
Practice Address - Street 1:320 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-0514
Practice Address - Country:US
Practice Address - Phone:620-356-3400
Practice Address - Fax:620-356-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS680341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590496169OtherRAILROAD MEDICARE
KS112013OtherBCBS
1521952OtherUNITED MINE WORKERS
KS100092030AMedicaid
112013GRMedicare ID - Type Unspecified