Provider Demographics
NPI:1972507390
Name:CITY OF KINGMAN
Entity Type:Organization
Organization Name:CITY OF KINGMAN
Other - Org Name:KINGMAN EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUKUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-532-3111
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-0168
Mailing Address - Country:US
Mailing Address - Phone:620-532-5624
Mailing Address - Fax:620-532-2393
Practice Address - Street 1:332 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1303
Practice Address - Country:US
Practice Address - Phone:620-532-5624
Practice Address - Fax:620-532-1293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF KINGMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005798OtherBCBS ID#
KS100092090AMedicaid
KS005798Medicare PIN