Healthcare Provider Details

I. General information

NPI: 1295792869
Provider Name (Legal Business Name): COUNTY OF STANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S FRONTAGE ROAD
JOHNSON KS
67855-0572
US

IV. Provider business mailing address

BOX 572 101 S. FRONTAGE ROAD
JOHNSON KS
67855-0572
US

V. Phone/Fax

Practice location:
  • Phone: 620-492-6879
  • Fax: 620-492-1445
Mailing address:
  • Phone: 620-492-6879
  • Fax: 620-492-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1860
License Number StateKS

VIII. Authorized Official

Name: ROGER L RICHARDSON
Title or Position: DIRECTOR
Credential:
Phone: 620-492-6879