Healthcare Provider Details

I. General information

NPI: 1053336040
Provider Name (Legal Business Name): COUNTY OF CLARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 HIGHLAND
ASHLAND KS
67831-0745
US

IV. Provider business mailing address

913 HIGHLAND P.O. BOX 745
ASHLAND KS
67831-0745
US

V. Phone/Fax

Practice location:
  • Phone: 620-635-2624
  • Fax: 620-635-2870
Mailing address:
  • Phone: 620-635-2624
  • Fax: 620-635-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY ANN CUNNINGHAM
Title or Position: RN ADMINISTRATOR
Credential: RN
Phone: 620-635-2624