Provider Demographics
NPI:1083777585
Name:PRAIRIE VIEW, INC.
Entity Type:Organization
Organization Name:PRAIRIE VIEW, INC.
Other - Org Name:PRAIRIE VIEW, INC-PARTIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-284-6310
Mailing Address - Street 1:1901 E 1ST ST
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-5010
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6491
Practice Address - Street 1:1901 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5010
Practice Address - Country:US
Practice Address - Phone:316-284-6400
Practice Address - Fax:316-284-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2084P0800X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA001OtherTRICARE
KS000215OtherBLUE CROSS BLUE SHIELD
KS100229030AMedicaid