Provider Demographics
NPI:1154458081
Name:COUNTY OF CHAUTAUQUA
Entity type:Organization
Organization Name:COUNTY OF CHAUTAUQUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCNOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-725-5850
Mailing Address - Street 1:215 N CHAUTAUQUA ST
Mailing Address - Street 2:
Mailing Address - City:SEDAN
Mailing Address - State:KS
Mailing Address - Zip Code:67361-1326
Mailing Address - Country:US
Mailing Address - Phone:620-725-5850
Mailing Address - Fax:620-725-5856
Practice Address - Street 1:215 N CHAUTAUQUA ST
Practice Address - Street 2:
Practice Address - City:SEDAN
Practice Address - State:KS
Practice Address - Zip Code:67361-1326
Practice Address - Country:US
Practice Address - Phone:620-725-5850
Practice Address - Fax:620-725-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS013290OtherBLUE CROSS-BLUE SHIELD
KS100114370AMedicaid
KS013290OtherBLUE CROSS-BLUE SHIELD