Provider Demographics
NPI:1295704054
Name:CITY OF CENTRALIA
Entity type:Organization
Organization Name:CITY OF CENTRALIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-857-3764
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:517 4TH STREET
Mailing Address - City:CENTRALIA
Mailing Address - State:KS
Mailing Address - Zip Code:66415-0247
Mailing Address - Country:US
Mailing Address - Phone:785-857-3764
Mailing Address - Fax:785-857-3372
Practice Address - Street 1:708 SECOND ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:KS
Practice Address - Zip Code:66415-0247
Practice Address - Country:US
Practice Address - Phone:785-857-3526
Practice Address - Fax:785-857-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100242980AMedicaid
KS005686Medicare ID - Type Unspecified
KS100242980AMedicaid