=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104841196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF FORD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 09/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 E SPRUCE ST
-----------------------------------------------------
City | DODGE CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67801-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-227-4545
-----------------------------------------------------
Fax | 620-227-4738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 E SPRUCE ST
-----------------------------------------------------
City | DODGE CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67801-4910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-227-4545
-----------------------------------------------------
Fax | 620-227-4738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ANGELA ELDER SOWERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-227-4545
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------