Provider Demographics
NPI:1972640720
Name:COUNTY OF SEDGWICK
Entity Type:Organization
Organization Name:COUNTY OF SEDGWICK
Other - Org Name:SEDGWICK COUNTY TRANSPORTATION BROKERAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-442-4811
Mailing Address - Street 1:1015 W STILLWELL ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4450
Mailing Address - Country:US
Mailing Address - Phone:316-383-7324
Mailing Address - Fax:
Practice Address - Street 1:1015 W STILLWELL ST FL 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4450
Practice Address - Country:US
Practice Address - Phone:316-383-7324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100318010AMedicaid