| Prairie Band Potawatomi Nation | |
|
11400 158th Rd Mayetta KS 66509-0249 | |
| (785) 966-8200 | |
| (785) 966-8393 |
| Full Name | Prairie Band Potawatomi Nation |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 11400 158th Rd, Mayetta, Kansas |
| Authorized Official Name and Position | Tiffany Lewis (BUSINESS OFFICE MANAGER) |
| Authorized Official Contact | 7859668282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Band Potawatomi Nation 11400 158th Rd Mayetta KS 66509-0249 Ph: (785) 966-8200 | Prairie Band Potawatomi Nation 11400 158th Rd Mayetta KS 66509-0249 Ph: (785) 966-8200 |
| NPI Number | 1245266410 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245266410 | NPI | - | NPPES |
| 200259300A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (Kansas) | Secondary |