Healthcare Provider Details

I. General information

NPI: 1477506434
Provider Name (Legal Business Name): COUNTY OF WILSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N 7TH ST
FREDONIA KS
66736-1342
US

IV. Provider business mailing address

421 N 7TH ST
FREDONIA KS
66736-1342
US

V. Phone/Fax

Practice location:
  • Phone: 620-378-4455
  • Fax: 620-378-4647
Mailing address:
  • Phone: 620-378-4455
  • Fax: 620-378-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD DURHAM
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 620-378-4455