=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093792046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF JOHNSON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2005
-----------------------------------------------------
Last Update Date | 12/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11811 S SUNSET DR STE. 1100
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-7055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-715-1950
-----------------------------------------------------
Fax | 913-715-1959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11811 S SUNSET DR STE. 1100
-----------------------------------------------------
City | OLATHE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66061-2793
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-715-1950
-----------------------------------------------------
Fax | 913-715-1959
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DEB A STANTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-715-1974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 900
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------