Healthcare Provider Details

I. General information

NPI: 1285734236
Provider Name (Legal Business Name): COUNTY OF CLARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 HIGHLAND STREET
ASHLAND KS
67831-0886
US

IV. Provider business mailing address

PO BOX 886 913 HIGHLAND
ASHLAND KS
67831-0886
US

V. Phone/Fax

Practice location:
  • Phone: 620-635-2832
  • Fax: 620-635-2992
Mailing address:
  • Phone: 620-635-2832
  • Fax: 620-635-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number340
License Number StateKS

VIII. Authorized Official

Name: MS. RAMONA J MYERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 620-635-2832