Provider Demographics
NPI:1134554314
Name:GREAT PLAINS OF CHEYENNE COUNTY INC.
Entity type:Organization
Organization Name:GREAT PLAINS OF CHEYENNE COUNTY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:210 W FIRST
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756-0547
Mailing Address - Country:US
Mailing Address - Phone:785-332-2104
Mailing Address - Fax:785-332-3255
Practice Address - Street 1:210 W FIRST
Practice Address - Street 2:
Practice Address - City:ST. FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756-0547
Practice Address - Country:US
Practice Address - Phone:785-332-2104
Practice Address - Fax:785-332-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-012-001333300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200462460AMedicaid
KS000162OtherBCBS
KS200462460AMedicaid