Organization
POTTAWATOMIE WABAUNSEE INFANT TODDLER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE BILDERBACK (DIRECTOR)
(785) 456-7366
Entity
Organization
Contact information
Practice address
510 E HWY 24, WAMEGO, KS 66547
(785) 456-7366
Mailing address
PO BOX 189, GIRARD, KS 66743-0189
(620) 724-6281
(620) 724-7141
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100212080B
—
KS
Enumeration date
07/24/2006
Last updated
07/23/2008
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