=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174927362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHEAST KANSAS MULTI-COUNTY HEALTH DEPARTMENTS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2014
-----------------------------------------------------
Last Update Date | 01/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 907 S 2ND ST
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66434-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-742-7192
-----------------------------------------------------
Fax | 785-742-4237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 907 S 2ND ST
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66434-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-742-7192
-----------------------------------------------------
Fax | 785-742-4237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | KRISTINA NICOLE ROMINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-742-7192
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | KSA007001
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------