Healthcare Provider Details

I. General information

NPI: 1780934927
Provider Name (Legal Business Name): COUNTY OF LOGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S RANGE AVE
COLBY KS
67701-2931
US

IV. Provider business mailing address

175 S RANGE AVE
COLBY KS
67701-2931
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-3332
  • Fax:
Mailing address:
  • Phone: 785-462-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEE SHANE MEYER
Title or Position: CFO
Credential:
Phone: 785-672-1409