Healthcare Provider Details

I. General information

NPI: 1700110707
Provider Name (Legal Business Name): BARBER COUNTY NORTH USD 254
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S MAIN ST
MEDICINE LODGE KS
67104-1514
US

IV. Provider business mailing address

308 S. MAIN
MEDICINE LODGE KS
67104-0288
US

V. Phone/Fax

Practice location:
  • Phone: 620-886-3370
  • Fax:
Mailing address:
  • Phone: 620-886-3370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY CULLEN
Title or Position: SUPERINTENDENT
Credential: MS
Phone: 620-886-3370