Basic Information
| Provider Information | |||||||||
| NPI: | 1831180033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNTY OF SEDGWICK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 271 W 3RD ST N STE 600 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672021223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3169415075 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672033602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3166607510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | TAMMANY | ||||||||
| AuthorizedOfficialFirstName: | JOAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3166607665 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 100056230C | 05 | KS | MEDICAID | 100237150F | 05 | KS | MEDICAID | 006904 | 01 | KS | BCBS GROUP # | OTHER | 100229160A | 05 | KS | MEDICAID | 116044 | 01 | KS | BLUE CROSS OSAF PROV # | OTHER | 324716 | 01 | KS | VALUE OPTIONS PROV # | OTHER | 100056230A | 05 | KS | MEDICAID | 100080500B | 05 | KS | MEDICAID |