Provider Demographics
NPI:1497201347
Name:KONZA PRAIRIE COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:KONZA PRAIRIE COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-238-4711
Mailing Address - Street 1:361 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-4201
Mailing Address - Country:US
Mailing Address - Phone:785-238-4711
Mailing Address - Fax:785-238-4260
Practice Address - Street 1:2030 TECUMSEH RD STE 100
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3512
Practice Address - Country:US
Practice Address - Phone:785-320-7134
Practice Address - Fax:785-530-6150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KONZA PRAIRIE COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-31
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212260EMedicaid