Healthcare Provider Details

I. General information

NPI: 1407899685
Provider Name (Legal Business Name): COUNTY OF ELLSWORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 EVANS ST
ELLSWORTH KS
67439-2553
US

IV. Provider business mailing address

1107 EVANS ST
ELLSWORTH KS
67439-2553
US

V. Phone/Fax

Practice location:
  • Phone: 785-472-3454
  • Fax: 785-472-3644
Mailing address:
  • Phone: 785-472-3454
  • Fax: 785-472-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number570
License Number StateKS

VIII. Authorized Official

Name: MR. RODERIC J REES
Title or Position: DIRECTOR
Credential: PARAMEDIC
Phone: 785-472-3454