Healthcare Provider Details

I. General information

NPI: 1578776589
Provider Name (Legal Business Name): COUNTY OF OSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E 9TH
LYNDON KS
66451
US

IV. Provider business mailing address

103 E 9TH
LYNDON KS
66451
US

V. Phone/Fax

Practice location:
  • Phone: 785-828-3117
  • Fax: 785-828-3848
Mailing address:
  • Phone: 785-828-3117
  • Fax: 785-828-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNE M GRAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-828-3117