MEDICARE: COUNTY OF HARPER

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	9-01316	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590007680	OTHER	KS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019028	OTHER	KS	BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467401851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF HARPER

Provider Business Mailing Address
First Line	:	123 N JENNINGS AVE
Second Line	:	PO BOX 251
City	:	ANTHONY
State	:	KS
Zip	:	67003-2708
Country	:	US
Telephone Number	:	620-842-3506
Fax Number	:	620-842-3309

Provider Business Practice Location Address
First Line	:	123 N JENNINGS AVE
Second Line	:
City	:	ANTHONY
State	:	KS
Zip	:	67003-2708
Country	:	US
Telephone Number	:	620-842-3506
Fax Number	:	620-842-3309

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MIKE LOREG
Credential	:	MICT
Telephone Number	:	620-842-3506

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/28/2010

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1336146034 — COUNTY OF HARPER
Practice Location Address:

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67003-2708

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1194702712 — CHARLES CADDY II RPA-C
Practice Location Address:

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Directions to “COUNTY OF HARPER ” Practice Location

Language	Start Address	Practice Location

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