Provider Demographics
NPI:1205899499
Name:COUNTY OF LOGAN
Entity type:Organization
Organization Name:COUNTY OF LOGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:785-672-1027
Mailing Address - Street 1:710 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:KS
Mailing Address - Zip Code:67748-1271
Mailing Address - Country:US
Mailing Address - Phone:785-672-1027
Mailing Address - Fax:785-672-0031
Practice Address - Street 1:703 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:KS
Practice Address - Zip Code:67748-1269
Practice Address - Country:US
Practice Address - Phone:785-671-0031
Practice Address - Fax:785-671-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-09
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1120341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100091660BMedicaid
KS005586Medicare ID - Type Unspecified