MEDICARE: COUNTY OF STAFFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346287752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF STAFFORD

Provider Business Mailing Address
First Line	:	610 E 1ST AVE
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-2224
Country	:	US
Telephone Number	:	620-549-3504
Fax Number	:	620-549-6593

Provider Business Practice Location Address
First Line	:	610 E 1ST AVE
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-2224
Country	:	US
Telephone Number	:	620-549-3504
Fax Number	:	620-549-6593

Authorized Official
Title or Position	:	ADMIN
Name	:	DORIS E TOMPKINS
Credential	:	RN
Telephone Number	:	620-549-3504

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/14/2008

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Directions to “COUNTY OF STAFFORD ” Practice Location

Language	Start Address	Practice Location

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