=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295704054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF CENTRALIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2006
-----------------------------------------------------
Last Update Date | 01/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 708 SECOND ST
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66415-0247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-857-3526
-----------------------------------------------------
Fax | 785-857-3372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 247 517 4TH STREET
-----------------------------------------------------
City | CENTRALIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66415-0247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-857-3764
-----------------------------------------------------
Fax | 785-857-3372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CITY CLERK
-----------------------------------------------------
Name | DOROTHY A WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-857-3764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 270
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------