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NPI Code Detail

MEDICARE: COUNTY OF DECATUR

MEDICARE: COUNTY OF DECATUR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2012748OTHERKSBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1033105358
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF DECATUR
Provider Business Mailing Address
First Line : 902 W COLUMBIA ST
Second Line :
City : OBERLIN
State : KS
Zip : 67749-2412
Country : US
Telephone Number : 785-475-8118
Fax Number : 785-475-8143
Provider Business Practice Location Address
First Line : 902 W COLUMBIA ST
Second Line :
City : OBERLIN
State : KS
Zip : 67749-2412
Country : US
Telephone Number : 785-475-8118
Fax Number : 785-475-8143
Authorized Official
Title or Position : ADMINISTRATOR
Name : MISS MARILYN M GAMBLIN
Credential : RN
Telephone Number : 785-475-8118
Provider Enumeration Date : 09/22/2005
Last Update Date : 10/07/2008

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Directions to “COUNTY OF DECATUR ” Practice Location

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