Provider Demographics
NPI:1811074123
Name:COUNTY OF MORTON
Entity type:Organization
Organization Name:COUNTY OF MORTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHIANNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-697-2612
Mailing Address - Street 1:625 COLORADO STREET
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0973
Mailing Address - Country:US
Mailing Address - Phone:620-697-2612
Mailing Address - Fax:620-697-2790
Practice Address - Street 1:625 COLORADO STREET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-0973
Practice Address - Country:US
Practice Address - Phone:620-697-2612
Practice Address - Fax:620-697-2790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12789OtherBLUE CROSS & BLUE SHILED
KS12789OtherBLUE CROSS & BLUE SHILED