Provider Demographics
NPI:1851341978
Name:COUNTY OF LINCOLN
Entity Type:Organization
Organization Name:COUNTY OF LINCOLN
Other - Org Name:LINCOLN COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-524-4757
Mailing Address - Street 1:216 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:KS
Mailing Address - Zip Code:67455-2058
Mailing Address - Country:US
Mailing Address - Phone:785-524-4757
Mailing Address - Fax:785-524-5008
Practice Address - Street 1:102 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:KS
Practice Address - Zip Code:67455-1928
Practice Address - Country:US
Practice Address - Phone:785-524-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS399220Other1ST GUARD HEALTH
KS100243410AMedicaid
KS100243410AMedicaid