Provider Demographics
NPI:1871527556
Name:COUNTY OF SHERMAN
Entity type:Organization
Organization Name:COUNTY OF SHERMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DORENDO
Authorized Official - Middle Name:RA
Authorized Official - Last Name:HARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-890-4888
Mailing Address - Street 1:1622 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-3053
Mailing Address - Country:US
Mailing Address - Phone:785-890-4888
Mailing Address - Fax:785-890-4891
Practice Address - Street 1:1622 BROADWAY
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-3053
Practice Address - Country:US
Practice Address - Phone:785-890-4888
Practice Address - Fax:785-890-4891
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SHERMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100116010AMedicaid
KS100116010AOtherUNICARE
KS629-740OtherHEALTHWAVE
KS013291OtherBLUECROSS BLUESHIELD
KS013291OtherBLUECROSS BLUESHIELD