1285843680 NPI number — GREAT PLAINS OF CHEYENNE CO INC

Table of content: (NPI 1285843680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285843680 NPI number — GREAT PLAINS OF CHEYENNE CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT PLAINS OF CHEYENNE CO 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:
CHEYENNE COUNTY HOSPITAL WORK COMP
Provider Other Organization Name Type Code:
3
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:
1285843680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 W FIRST STREET
Provider Second Line Business Mailing Address:
PO BOX 547
Provider Business Mailing Address City Name:
ST. FRANCIS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67756-0547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-332-2104
Provider Business Mailing Address Fax Number:
785-332-3255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 W FIRST STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST FRANCIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67756-0547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-332-2104
Provider Business Practice Location Address Fax Number:
785-332-3255
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CLINGENPEEL
Authorized Official First Name:
JEREMY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
785-332-2104

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 610593000 . This is a "WORK COMP" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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