Provider Demographics
NPI:1760581466
Name:PRAIRIE FAMILY MEDICINE ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PRAIRIE FAMILY MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-234-0880
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66601-1754
Mailing Address - Country:US
Mailing Address - Phone:785-234-0880
Mailing Address - Fax:
Practice Address - Street 1:631 SW HORNE ST STE 300
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1663
Practice Address - Country:US
Practice Address - Phone:785-234-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110952Medicare ID - Type Unspecified