Provider Demographics
NPI:1487758702
Name:CITY OF WATERVILLE
Entity type:Organization
Organization Name:CITY OF WATERVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WANAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:ADVANCED EMERGENCY M
Authorized Official - Phone:785-363-2367
Mailing Address - Street 1:P.O. BOX 387
Mailing Address - Street 2:136 E. COMMERCIAL
Mailing Address - City:WATERVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66548
Mailing Address - Country:US
Mailing Address - Phone:785-363-2367
Mailing Address - Fax:785-363-2524
Practice Address - Street 1:136 E. COMMERCIAL
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:KS
Practice Address - Zip Code:66548
Practice Address - Country:US
Practice Address - Phone:785-363-2367
Practice Address - Fax:785-363-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2060341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100243540AMedicaid
KS=========OtherCOMMERCIAL INS. NUMBER
KS112007Medicare ID - Type UnspecifiedMEDICARE NUMBER
KS=========OtherCOMMERCIAL INS. NUMBER
KS100243540AMedicaid