Organization
PHILLIPS COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LOUETTA JOANN FORELL RN (ADMINISTRATOR/HEALTH OFFICER)
(785) 543-6850
Entity
Organization
Contact information
Practice address
784 6TH ST, PHILLIPSBURG, KS 67661-1939
(785) 543-6850
(785) 543-6852
Mailing address
784 6TH ST, PHILLIPSBURG, KS 67661-1939
(785) 543-6850
(785) 543-6852
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000525
BLUE SHIELD HOME HEALTH
KS
01
—
012764
BLUE SHIELD PROVIDER NUMBER
KS
05
—
100011960A
—
KS
05
—
100092360A
—
KS
05
—
100092360B
—
KS
01
—
629780
FIRST GUARD PROVIDER NUMBER
KS
Enumeration date
09/12/2005
Last updated
08/02/2010
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