1760767339 NPI number — GREAT PLAINS OF OTTAWA CO, INC.

Table of content: (NPI 1760767339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760767339 NPI number — GREAT PLAINS OF OTTAWA CO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT PLAINS OF OTTAWA 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:
Provider Other Organization Name Type Code:
6
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:
1760767339
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 290
Provider Second Line Business Mailing Address:
215 E 8TH ST,
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67467-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-392-2122
Provider Business Mailing Address Fax Number:
785-392-2852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 E 8TH ST,
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67467-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-392-2122
Provider Business Practice Location Address Fax Number:
785-392-2852
Provider Enumeration Date:
10/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PARKS
Authorized Official First Name:
JODY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
785-392-9131

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  H072001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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