Provider Demographics
NPI:1972606580
Name:COUNTY OF LEAVENWORTH
Entity type:Organization
Organization Name:COUNTY OF LEAVENWORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MICT
Authorized Official - Phone:913-250-8000
Mailing Address - Street 1:500 EISENHOWER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5161
Mailing Address - Country:US
Mailing Address - Phone:913-250-8000
Mailing Address - Fax:913-250-0063
Practice Address - Street 1:500 EISENHOWER RD STE 103
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5161
Practice Address - Country:US
Practice Address - Phone:913-250-8000
Practice Address - Fax:913-250-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1010341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
291732OtherCAPITOL BCBS
MO035970OtherFIRST GAURD MEDICAID HMO
20842016OtherBCBS OF KANSAS CITY
KS100091480CMedicaid
590077899OtherRAILROAD MEDICARE PGBA
144275700OtherKANSAS DEPT OF LABOR
NY10523977Medicaid
OK200085760AMedicaid
MO800465007Medicaid
OK200085760AMedicaid
OK200085760AMedicaid