| Iroquois Center For Human Development, Inc. | |
|
610 E Grant Ave Greensburg KS 67054-2708 | |
| (620) 723-2272 | |
| (620) 723-3450 |
| Full Name | Iroquois Center For Human Development, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 610 E Grant Ave, Greensburg, Kansas |
| Authorized Official Name and Position | Charles Sheldon Carpenter (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6207232272 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iroquois Center For Human Development, Inc. 610 E Grant Ave Greensburg KS 67054-2708 Ph: (620) 723-2272 | Iroquois Center For Human Development, Inc. 610 E Grant Ave Greensburg KS 67054-2708 Ph: (620) 723-2272 |
| NPI Number | 1922001981 |
|---|---|
| Provider Enumeration Date | 05/24/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2062314081 |
|---|---|
| Medicare Enrollment ID | O20040915000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922001981 | NPI | - | NPPES |
| 100098110B | Medicaid | KS | |
| 100098110A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kurt Daniel Leis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568466043 PECOS PAC ID: 8224028931 Enrollment ID: I20040514000709 |
| Provider Name | Ric A Dalke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851516496 PECOS PAC ID: 7517907546 Enrollment ID: I20050509000765 |
| Provider Name | Trever A Krehbiel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720284250 PECOS PAC ID: 8426245036 Enrollment ID: I20101208001111 |
| Provider Name | Stephanie J Salisbury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740588953 PECOS PAC ID: 7315295508 Enrollment ID: I20180803001930 |
| Provider Name | Cheryl R Gore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710375050 PECOS PAC ID: 6305157645 Enrollment ID: I20180924001713 |
| Provider Name | Tracy J Caldwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861162323 PECOS PAC ID: 8729477575 Enrollment ID: I20211116002153 |
| Provider Name | Julia Butler |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821103102 PECOS PAC ID: 1153764204 Enrollment ID: I20240206002974 |
| Provider Name | Scott G Rogers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073628525 PECOS PAC ID: 1557704616 Enrollment ID: I20240206003605 |
| Provider Name | Charles L Stephens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245355361 PECOS PAC ID: 4587007547 Enrollment ID: I20240206003910 |
| Provider Name | James Ryckert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932650660 PECOS PAC ID: 7618311523 Enrollment ID: I20240220000692 |