Provider Demographics
NPI:1457690307
Name:GRAY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:GRAY COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-855-2424
Mailing Address - Street 1:300 SOUTH MAIN
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0487
Mailing Address - Country:US
Mailing Address - Phone:620-855-2424
Mailing Address - Fax:620-855-7007
Practice Address - Street 1:300 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0487
Practice Address - Country:US
Practice Address - Phone:620-855-2424
Practice Address - Fax:620-855-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100113640AMedicaid