Provider Demographics
NPI:1689246753
Name:PRATT REGIONAL MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:PRATT REGIONAL MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-672-7451
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 1:1600 E 1ST ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2070
Practice Address - Country:US
Practice Address - Phone:620-672-7451
Practice Address - Fax:620-672-2113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRATT REGIONAL MEDICAL CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty