Provider Demographics
NPI:1043257850
Name:COUNTY OF GRANT
Entity type:Organization
Organization Name:COUNTY OF GRANT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRAZEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-356-1545
Mailing Address - Street 1:105 S. GLENN
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2546
Mailing Address - Country:US
Mailing Address - Phone:620-356-1545
Mailing Address - Fax:620-424-1164
Practice Address - Street 1:105 S. GLENN
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2546
Practice Address - Country:US
Practice Address - Phone:620-356-1545
Practice Address - Fax:620-424-1164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF GRANT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097860AMedicaid
KS100097860AMedicaid