Provider Demographics
NPI:1063757136
Name:HAYSVILLE MEDICAL TRANSPORT
Entity type:Organization
Organization Name:HAYSVILLE MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:316-727-9372
Mailing Address - Street 1:1931 W COUNTRY LAKES ST
Mailing Address - Street 2:
Mailing Address - City:HAYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67060-5601
Mailing Address - Country:US
Mailing Address - Phone:316-727-9372
Mailing Address - Fax:316-260-6480
Practice Address - Street 1:146 N LAMAR AVE
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-1229
Practice Address - Country:US
Practice Address - Phone:316-727-9372
Practice Address - Fax:316-260-6480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAYSVILLE MENTAL HEALTH & SUBSTANCE ABUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200602370AMedicaid