Healthcare Provider Details

I. General information

NPI: 1538159223
Provider Name (Legal Business Name): PHILLIPS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E ST
PHILLIPSBURG KS
67661-1656
US

IV. Provider business mailing address

409 E ST PO BOX 309
PHILLIPSBURG KS
67661-1656
US

V. Phone/Fax

Practice location:
  • Phone: 785-543-6805
  • Fax: 785-543-6806
Mailing address:
  • Phone: 785-543-6805
  • Fax: 785-543-6806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number1510
License Number StateKS

VIII. Authorized Official

Name: MARY JAYNE HOLLE
Title or Position: ADMINISTRATOR
Credential: BSN RN MICT
Phone: 785-543-6805