Healthcare Provider Details

I. General information

NPI: 1285629535
Provider Name (Legal Business Name): COUNTY OF LOGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAPLE AVE
OAKLEY KS
67748-1220
US

IV. Provider business mailing address

212 MAPLE AVE
OAKLEY KS
67748-1220
US

V. Phone/Fax

Practice location:
  • Phone: 785-672-3261
  • Fax: 785-672-8194
Mailing address:
  • Phone: 785-672-3261
  • Fax: 785-672-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEE SHANE MEYER
Title or Position: CFO
Credential:
Phone: 785-672-8184