Provider Demographics
NPI:1245321819
Name:PRATT REGIONAL MEDICAL CENTER CORPORATION
Entity type:Organization
Organization Name:PRATT REGIONAL MEDICAL CENTER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-672-7451
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67578-0309
Mailing Address - Country:US
Mailing Address - Phone:620-234-6826
Mailing Address - Fax:620-234-5014
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVIA
Practice Address - State:KS
Practice Address - Zip Code:67581
Practice Address - Country:US
Practice Address - Phone:620-486-2985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRATT REGIONAL MEDICAL CENTER CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100071250EMedicaid
KS178526Medicare Oscar/Certification