Provider Demographics
NPI:1013972041
Name:CITY OF HESSTON
Entity Type:Organization
Organization Name:CITY OF HESSTON
Other - Org Name:HESSTON AMBULANCE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF EMERGENCY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MICT
Authorized Official - Phone:620-327-4412
Mailing Address - Street 1:115 EAST SMITH STREET
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062
Mailing Address - Country:US
Mailing Address - Phone:620-327-4412
Mailing Address - Fax:620-327-4595
Practice Address - Street 1:115 EAST SMITH STREET
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062
Practice Address - Country:US
Practice Address - Phone:620-327-4412
Practice Address - Fax:620-327-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS790146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005667Medicare ID - Type UnspecifiedPROVIDER NUMBER