Provider Demographics
NPI:1871568691
Name:COUNTY OF SUMNER
Entity type:Organization
Organization Name:COUNTY OF SUMNER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-326-2774
Mailing Address - Street 1:217 W 8TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WELLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67152-3922
Mailing Address - Country:US
Mailing Address - Phone:620-326-2774
Mailing Address - Fax:620-326-2738
Practice Address - Street 1:217 W 8TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-3922
Practice Address - Country:US
Practice Address - Phone:620-326-2774
Practice Address - Fax:620-326-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100014440AMedicaid
KS17D0648309OtherCLIA NUMBER
KS100014440AMedicaid