Provider Demographics
NPI:1679567721
Name:CITY OF ELLINWOOD
Entity Type:Organization
Organization Name:CITY OF ELLINWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:620-564-2408
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-0278
Mailing Address - Country:US
Mailing Address - Phone:620-564-2408
Mailing Address - Fax:620-564-2401
Practice Address - Street 1:104 E 2ND ST
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-1627
Practice Address - Country:US
Practice Address - Phone:620-564-2408
Practice Address - Fax:620-564-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS550146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100092010-AMedicaid
KS100092010-AMedicaid