Provider Demographics
NPI:1962648287
Name:PRAIRIE FAMILY HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:PRAIRIE FAMILY HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:605-996-5553
Mailing Address - Street 1:1115 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2917
Mailing Address - Country:US
Mailing Address - Phone:605-996-5553
Mailing Address - Fax:605-996-1213
Practice Address - Street 1:1115 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2917
Practice Address - Country:US
Practice Address - Phone:605-996-5553
Practice Address - Fax:605-996-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000190261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center