NPIMap

Organization Active NPI

Phillips County

  • Emergency Medical Services (Emergency Medicine) Physician
  • Phillipsburg, KS
National Provider Identifier
1104815265
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
1510 Issued in KS
Legal business name
PHILLIPS COUNTY
Practice address
409 E St
Box 309
Phillipsburg, KS 67661-1656
Phone
(785) 543-6805
Fax
(785) 543-6806
NPI assigned
Oct 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Jayne Holle, BSN RN MICT
Title
Administrator
Phone
(785) 543-6805

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207PE0004X 1510 KS Primary

Addresses

Primary practice location

409 E St
Box 309
Phillipsburg, KS 67661-1656

Mailing address

409 E St
Phillipsburg, KS 67661-1656
Phone (785) 543-6805

Other identifiers 1

IdentifierTypeStateIssuer
100092360DMedicaidKS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050516000048 KS Part B Supplier - Ambulance Service Supplier 3274580402 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Agra, KS; Kirwin, KS; Logan, KS; Long Island, KS; Phillipsburg, KS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Phillips County6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

409 E St
#309
Phillipsburg, KS 67661
Phone (785) 543-6805

409 E St
Phillipsburg, KS 67661
Phone (785) 543-6805

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1104815265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 E ST",
            "city": "PHILLIPSBURG",
            "state": "KS",
            "postal_code": "676611656",
            "telephone_number": "785-543-6805",
            "fax_number": "785-543-6806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 E ST",
            "address_2": "BOX 309",
            "city": "PHILLIPSBURG",
            "state": "KS",
            "postal_code": "676611656",
            "telephone_number": "785-543-6805",
            "fax_number": "785-543-6806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIPS COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "HOLLE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JAYNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "785-543-6805",
        "authorized_official_credential": "BSN RN MICT"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "KS",
            "license": "1510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100092360D",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phillipsburg, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.