1306059662 NPI number — PRAIRIE VIEW, INC.

Table of content: (NPI 1306059662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306059662 NPI number — PRAIRIE VIEW, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAIRIE VIEW, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRAIRIE VIEW, INC - MARION D & A
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306059662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 467
Provider Second Line Business Mailing Address:
1901 E. 1ST ST.
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67114-0467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-284-6400
Provider Business Mailing Address Fax Number:
316-284-6491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 S. ASH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67063-0185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-947-3200
Provider Business Practice Location Address Fax Number:
620-947-3845
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KAYE
Authorized Official First Name:
JESSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
316-284-6400

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 00210714 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100005670L , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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