| Prairie Star Family Practice, P.a. | |
|
1210 N. Washington, Clinic B Plainville KS 67663-1632 | |
| (785) 434-2622 | |
| (785) 434-2577 |
| Full Name | Prairie Star Family Practice, P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 1210 N. Washington, Clinic B, Plainville, Kansas |
| Authorized Official Name and Position | Jennifer Brull (OWNER/PRESIDENT) |
| Authorized Official Contact | 7854342622 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Star Family Practice, P.a. 1210 N. Washington, Clinic B P.o. Box 407 Plainville KS 67663-0407 Ph: (785) 434-2622 | Prairie Star Family Practice, P.a. 1210 N. Washington, Clinic B Plainville KS 67663-1632 Ph: (785) 434-2622 |
| NPI Number | 1003929001 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 06/15/2010 |
| Medicare PECOS PAC ID | 3375619976 |
|---|---|
| Medicare Enrollment ID | O20080905000105 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003929001 | NPI | - | NPPES |
| 101898 | Other | KS | BC/BS INDIVIDUAL |
| 100376880C | Medicaid | KS | |
| 110760 | Other | KS | BC/BS GROUP |
| 662541 | Other | KS | FIRSTGUARD # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 04-28262 (Kansas) | Primary |
| Provider Name | Jennifer L Brull |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841303807 PECOS PAC ID: 0244274819 Enrollment ID: I20050614001238 |
Lifeline Family Medicine, P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1210 N. Washington, Clinic B, Plainville, KS 67663 Phone: 785-434-2622 Fax: 785-434-2577 | |
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Daniel J. Sanchez, M.d., P.a. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1210 N. Washington, Clinic B, Plainville, KS 67663 Phone: 785-434-2622 Fax: 785-434-2577 | |
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