Provider Demographics
NPI:1699760686
Name:COUNTY OF THOMAS
Entity type:Organization
Organization Name:COUNTY OF THOMAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HICKERT
Authorized Official - Suffix:II
Authorized Official - Credentials:RN, NREMT-P
Authorized Official - Phone:785-460-4585
Mailing Address - Street 1:1275 S FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3718
Mailing Address - Country:US
Mailing Address - Phone:785-460-4585
Mailing Address - Fax:785-460-4586
Practice Address - Street 1:1275 S FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3718
Practice Address - Country:US
Practice Address - Phone:785-460-4585
Practice Address - Fax:785-460-4586
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF THOMAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-15
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS19503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097850BMedicaid
KS112008OtherBLUE CROSS BLUE SHIELD
KS112008Medicare ID - Type Unspecified