Organization
COUNTY OF ELLIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KERRY G MCCUE (ADMINISTRATOR)
(785) 628-9440
Entity
Organization
Contact information
Practice address
2507 CANTERBURY DR, HAYS, KS 67601-2233
(785) 628-9440
(785) 628-0804
Mailing address
2507 CANTERBURY DR, HAYS, KS 67601-2233
(785) 628-9440
(785) 628-0804
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012726
BLUE CROSS/BLUE SHIELD
KS
05
—
100113480A
—
KS
01
—
629630
FIRSTGUARD
KS
Enumeration date
08/10/2005
Last updated
01/21/2019
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