Healthcare Provider Details

I. General information

NPI: 1295704054
Provider Name (Legal Business Name): CITY OF CENTRALIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 SECOND ST
CENTRALIA KS
66415-0247
US

IV. Provider business mailing address

PO BOX 247 517 4TH STREET
CENTRALIA KS
66415-0247
US

V. Phone/Fax

Practice location:
  • Phone: 785-857-3526
  • Fax: 785-857-3372
Mailing address:
  • Phone: 785-857-3764
  • Fax: 785-857-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number270
License Number StateKS

VIII. Authorized Official

Name: DOROTHY A WHITE
Title or Position: CITY CLERK
Credential:
Phone: 785-857-3764