Provider Demographics
NPI:1518165778
Name:PAWNEE MENTAL HLTH SERVICES
Entity Type:Organization
Organization Name:PAWNEE MENTAL HLTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYROLL & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-587-4300
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:
Practice Address - Street 1:2001 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3415
Practice Address - Country:US
Practice Address - Phone:785-587-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003919880003Medicaid
KS30003919880005Medicaid
KS30003919880007Medicaid
KS30003919880002Medicaid
KS30003919880009Medicaid
KS30003919880010Medicaid
KS30003919880001Medicaid
KS30003919880042Medicaid
KS30003919880043Medicaid
KS30003919880053Medicaid
KS30003919880004Medicaid
KS30003919880006Medicaid
KS30003919880008Medicaid
KS30003919880011Medicaid
KS30003919880056Medicaid