Provider Demographics
NPI:1700989092
Name:COUNTY OF MORTON
Entity type:Organization
Organization Name:COUNTY OF MORTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRILLHART
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:620-697-4251
Mailing Address - Street 1:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0863
Mailing Address - Country:US
Mailing Address - Phone:620-697-4251
Mailing Address - Fax:620-697-4261
Practice Address - Street 1:722 STEVENS AVENUE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950
Practice Address - Country:US
Practice Address - Phone:620-697-4251
Practice Address - Fax:620-697-4261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MORTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100092080BMedicaid
KS112035OtherBLUE CROSS BLUE SHIELD KS
KS392750OtherFIRST GUARD
KS392750OtherFIRST GUARD