Provider Demographics
NPI:1538244066
Name:CITY OF BURDETT
Entity type:Organization
Organization Name:CITY OF BURDETT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:IVE
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:AEMT
Authorized Official - Phone:620-960-2716
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:213 ELM
Mailing Address - City:BURDETT
Mailing Address - State:KS
Mailing Address - Zip Code:67523-0288
Mailing Address - Country:US
Mailing Address - Phone:620-525-6279
Mailing Address - Fax:620-525-6438
Practice Address - Street 1:209 ELM
Practice Address - Street 2:
Practice Address - City:BURDETT
Practice Address - State:KS
Practice Address - Zip Code:67523
Practice Address - Country:US
Practice Address - Phone:620-960-2716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS210341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119999Medicare ID - Type Unspecified