MEDICARE: CITY OF KINGMAN

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	950	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005798	OTHER	KS	BCBS ID#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972507390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF KINGMAN

Provider Business Mailing Address
First Line	:	PO BOX 168
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-0168
Country	:	US
Telephone Number	:	620-532-5624
Fax Number	:	620-532-2393

Provider Business Practice Location Address
First Line	:	332 N MAIN ST
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-1303
Country	:	US
Telephone Number	:	620-532-5624
Fax Number	:	620-532-1293

Authorized Official
Title or Position	:	CITY MANAGER
Name	:	MR. FRANK SOUKUP
Credential	:
Telephone Number	:	620-532-3111

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	04/10/2013

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Directions to “CITY OF KINGMAN ” Practice Location

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