Provider Demographics
NPI:1053336040
Name:COUNTY OF CLARK
Entity type:Organization
Organization Name:COUNTY OF CLARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-635-2624
Mailing Address - Street 1:913 HIGHLAND
Mailing Address - Street 2:P.O. BOX 745
Mailing Address - City:ASHLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67831-0745
Mailing Address - Country:US
Mailing Address - Phone:620-635-2624
Mailing Address - Fax:620-635-2870
Practice Address - Street 1:913 HIGHLAND
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KS
Practice Address - Zip Code:67831-0745
Practice Address - Country:US
Practice Address - Phone:620-635-2624
Practice Address - Fax:620-635-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12783OtherBC-BS
KS100091760AMedicaid
KS130565Medicare ID - Type Unspecified