=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497763965
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF OTTAWA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 06/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 817A ARGYLE AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67467-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-392-2822
-----------------------------------------------------
Fax | 785-392-3640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817A ARGYLE AVE
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67467-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-392-2822
-----------------------------------------------------
Fax | 785-392-3640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. SANDRA K CLINE
-----------------------------------------------------
Credential | RN BS
-----------------------------------------------------
Telephone | 785-392-2822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | NO NUMBER
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------