Organization
COUNTY OF CLARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ANN CUNNINGHAM RN (RN ADMINISTRATOR)
(620) 635-2624
Entity
Organization
Contact information
Practice address
913 HIGHLAND, ASHLAND, KS 67831-0745
(620) 635-2624
(620) 635-2870
Mailing address
913 HIGHLAND, P.O. BOX 745, ASHLAND, KS 67831-0745
(620) 635-2624
(620) 635-2870
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091760A
—
KS
01
—
12783
BC-BS
KS
Enumeration date
07/12/2006
Last updated
04/01/2010
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