Healthcare Provider Details

I. General information

NPI: 1598851412
Provider Name (Legal Business Name): CITY OF CLYDE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 WASHINGTON ST 412 WASHINGTON ST.
CLYDE KS
66938-9500
US

IV. Provider business mailing address

412 WASHINGTON ST P.O BOX 308
CLYDE KS
66938-9500
US

V. Phone/Fax

Practice location:
  • Phone: 785-446-2211
  • Fax: 785-446-3669
Mailing address:
  • Phone: 785-446-2211
  • Fax: 785-446-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number380
License Number StateKS

VIII. Authorized Official

Name: DENNIS STREIT
Title or Position: EMS DIRECTOR
Credential:
Phone: 785-446-2211