Organization
PHILLIPS COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JAYNE HOLLE BSN RN MICT (ADMINISTRATOR)
(785) 543-6805
Entity
Organization
Contact information
Practice address
409 E ST, BOX 309, PHILLIPSBURG, KS 67661-1656
(785) 543-6805
(785) 543-6806
Mailing address
409 E ST, PHILLIPSBURG, KS 67661-1656
(785) 543-6805
(785) 543-6806
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
1510
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092360D
—
KS
Enumeration date
10/20/2005
Last updated
04/30/2009
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