Provider Demographics
NPI:1306918255
Name:COUNTY OF TREGO
Entity type:Organization
Organization Name:COUNTY OF TREGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-743-6348
Mailing Address - Street 1:201 N MAIN
Mailing Address - Street 2:
Mailing Address - City:WAKEENEY
Mailing Address - State:KS
Mailing Address - Zip Code:67672
Mailing Address - Country:US
Mailing Address - Phone:785-743-6348
Mailing Address - Fax:785-743-5428
Practice Address - Street 1:201 N MAIN
Practice Address - Street 2:
Practice Address - City:WAKEENEY
Practice Address - State:KS
Practice Address - Zip Code:67672
Practice Address - Country:US
Practice Address - Phone:785-743-6348
Practice Address - Fax:785-743-5428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
629620OtherHEALTHWAVE
KS100116120AMedicaid
629620OtherHEALTHWAVE