Provider Demographics
NPI:1821044991
Name:COUNTY OF SHERIDAN
Entity Type:Organization
Organization Name:COUNTY OF SHERIDAN
Other - Org Name:SHERIDAN COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-675-3364
Mailing Address - Street 1:1717 OAK AVE
Mailing Address - Street 2:RT 1 BOX 941
Mailing Address - City:HOXIE
Mailing Address - State:KS
Mailing Address - Zip Code:67740-4188
Mailing Address - Country:US
Mailing Address - Phone:785-675-3364
Mailing Address - Fax:785-675-3367
Practice Address - Street 1:1717 OAK AVE
Practice Address - Street 2:RT 1 BOX 941
Practice Address - City:HOXIE
Practice Address - State:KS
Practice Address - Zip Code:67740-4188
Practice Address - Country:US
Practice Address - Phone:785-675-3364
Practice Address - Fax:785-675-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1790146M00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100070770AMedicaid
KS100070770AMedicaid