Provider Demographics
NPI:1982644936
Name:GREAT PLAINS OF CHEYENNE CO INC
Entity Type:Organization
Organization Name:GREAT PLAINS OF CHEYENNE CO INC
Other - Org Name:CHEYENNE COUNTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLINGENPEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-332-2104
Mailing Address - Street 1:221 W FIRST
Mailing Address - Street 2:PO BOX 1075
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756-1075
Mailing Address - Country:US
Mailing Address - Phone:785-332-2682
Mailing Address - Fax:785-332-2516
Practice Address - Street 1:221 W FIRST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756-1075
Practice Address - Country:US
Practice Address - Phone:785-332-2682
Practice Address - Fax:785-332-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003937290003Medicaid
CO38684748Medicaid
KS110731OtherBCBS
KS100409190CMedicaid