Provider Demographics
NPI:1023068236
Name:COUNTY OF KINGMAN
Entity type:Organization
Organization Name:COUNTY OF KINGMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISMAN-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-532-2221
Mailing Address - Street 1:125 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67068-1648
Mailing Address - Country:US
Mailing Address - Phone:620-532-2221
Mailing Address - Fax:620-532-1083
Practice Address - Street 1:125 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1648
Practice Address - Country:US
Practice Address - Phone:620-532-2221
Practice Address - Fax:620-532-1083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF KINGMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097760AMedicaid
KS629380OtherHEALTH WAVE
KS600000869OtherRAILROAD MEDICARE
KS012761Medicare UPIN
KS629380OtherHEALTH WAVE