Provider Demographics
NPI:1104815265
Name:PHILLIPS COUNTY
Entity type:Organization
Organization Name:PHILLIPS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:HOLLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN MICT
Authorized Official - Phone:785-543-6805
Mailing Address - Street 1:409 E ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661-1656
Mailing Address - Country:US
Mailing Address - Phone:785-543-6805
Mailing Address - Fax:785-543-6806
Practice Address - Street 1:409 E ST
Practice Address - Street 2:BOX 309
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1656
Practice Address - Country:US
Practice Address - Phone:785-543-6805
Practice Address - Fax:785-543-6806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1510207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100092360DMedicaid
KS100092360DMedicaid