Provider Demographics
NPI:1750509923
Name:STEVENS COUNTY SHERIFF
Entity Type:Organization
Organization Name:STEVENS COUNTY SHERIFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAJCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-684-5296
Mailing Address - Street 1:215 S OAK ST
Mailing Address - Street 2:108
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2862
Mailing Address - Country:US
Mailing Address - Phone:509-684-5296
Mailing Address - Fax:
Practice Address - Street 1:215 S OAK ST
Practice Address - Street 2:108
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2862
Practice Address - Country:US
Practice Address - Phone:509-684-5296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9130030Medicaid