Provider Demographics
NPI:1578596904
Name:PRATT REGIONAL MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:PRATT REGIONAL MEDICAL CENTER CORPORATION
Other - Org Name:PRATT REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-450-1160
Mailing Address - Street 1:200 COMMODORE ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2903
Mailing Address - Country:US
Mailing Address - Phone:620-672-7451
Mailing Address - Fax:620-672-2113
Practice Address - Street 1:200 COMMODORE ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2903
Practice Address - Country:US
Practice Address - Phone:620-672-7451
Practice Address - Fax:620-672-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH076001282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099320AMedicaid
KS100099320AMedicaid