Provider Demographics
NPI:1912316811
Name:GREAT PLAINS DIABETES RESEARCH, INC
Entity Type:Organization
Organization Name:GREAT PLAINS DIABETES RESEARCH, INC
Other - Org Name:GREAT PLAINS DIABETES
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-440-2802
Mailing Address - Street 1:834 N SOCORA ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3279
Mailing Address - Country:US
Mailing Address - Phone:316-440-2802
Mailing Address - Fax:316-440-2809
Practice Address - Street 1:834 N SOCORA ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-440-2802
Practice Address - Fax:316-440-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74249364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty