Provider Demographics
NPI:1952316382
Name:JEWELL, LINCOLN, MITCHELL COUNTY
Entity Type:Organization
Organization Name:JEWELL, LINCOLN, MITCHELL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-738-3005
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-0189
Mailing Address - Country:US
Mailing Address - Phone:620-724-6281
Mailing Address - Fax:620-724-7141
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-2745
Practice Address - Country:US
Practice Address - Phone:785-738-3005
Practice Address - Fax:785-738-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100211830BMedicaid