Provider Demographics
NPI:1851473235
Name:COUNTY OF FORD
Entity type:Organization
Organization Name:COUNTY OF FORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMISSION CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:T
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:GOODNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-227-6465
Mailing Address - Street 1:PO BOX 48339
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-8339
Mailing Address - Country:US
Mailing Address - Phone:316-685-6161
Mailing Address - Fax:
Practice Address - Street 1:100 GUNSMOKE ST
Practice Address - Street 2:BOX 7
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4456
Practice Address - Country:US
Practice Address - Phone:620-227-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS610341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590496178OtherRAILROAD MEDICARE
CO5965077Medicaid
KS100092730BMedicaid
KS100092730BMedicaid
005897Medicare ID - Type Unspecified
KS100092730BMedicaid