Provider Demographics
NPI:1457355885
Name:COUNTY OF STAFFORD
Entity Type:Organization
Organization Name:COUNTY OF STAFFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SF CO COMMISSION CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRIMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-549-3509
Mailing Address - Street 1:636 E. 4TH
Mailing Address - Street 2:
Mailing Address - City:ST. JOHN
Mailing Address - State:KS
Mailing Address - Zip Code:67576
Mailing Address - Country:US
Mailing Address - Phone:620-549-3765
Mailing Address - Fax:
Practice Address - Street 1:636 E. 4TH
Practice Address - Street 2:
Practice Address - City:ST. JOHN
Practice Address - State:KS
Practice Address - Zip Code:67576
Practice Address - Country:US
Practice Address - Phone:620-549-3765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
KS18553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance