Provider Demographics
NPI:1417193301
Name:PRATT REGIONAL MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:PRATT REGIONAL MEDICAL CENTER CORP
Other - Org Name:PRATT REGIONAL ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-450-1146
Mailing Address - Street 1:200 COMMODORE
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124
Mailing Address - Country:US
Mailing Address - Phone:620-450-1146
Mailing Address - Fax:
Practice Address - Street 1:200 COMMODORE
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124
Practice Address - Country:US
Practice Address - Phone:620-450-1146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty