MEDICARE: COUNTY OF WALLACE

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
1	3416L0300X	Land Ambulance	2030	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015839	OTHER	KS	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396711362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF WALLACE

Provider Business Mailing Address
First Line	:	PO BOX 624
Second Line	:
City	:	SHARON SPRINGS
State	:	KS
Zip	:	67758-0624
Country	:	US
Telephone Number	:	785-852-4282
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 E SIXTH
Second Line	:
City	:	SHARON SPRINGS
State	:	KS
Zip	:	67758
Country	:	US
Telephone Number	:	785-852-4282
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NANCY SCHMIDT
Credential	:
Telephone Number	:	785-852-4282

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	12/12/2008

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Directions to “COUNTY OF WALLACE ” Practice Location

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