Provider Demographics
NPI:1174540256
Name:COUNTY OF LEAVENWORTH
Entity type:Organization
Organization Name:COUNTY OF LEAVENWORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH DEPARTMENT
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:
Authorized Official - Phone:913-250-2006
Mailing Address - Street 1:500 EISENHOWER RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4969
Mailing Address - Country:US
Mailing Address - Phone:913-250-2000
Mailing Address - Fax:913-250-2039
Practice Address - Street 1:500 EISENHOWER RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4969
Practice Address - Country:US
Practice Address - Phone:913-250-2000
Practice Address - Fax:913-250-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS630050Medicaid
KS100091480AMedicaid
KS100091480AMedicaid