Provider Demographics
NPI:1659566891
Name:HARVEY MARION COUNTY CDDO
Entity Type:Organization
Organization Name:HARVEY MARION COUNTY CDDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLENERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-283-7997
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2211
Mailing Address - Country:US
Mailing Address - Phone:316-283-7997
Mailing Address - Fax:316-283-7969
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2211
Practice Address - Country:US
Practice Address - Phone:316-283-7997
Practice Address - Fax:316-283-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service