PRAIRIE STAR FAMILY PRACTICE P.A. NPI 1003929001

NPI Information

NPI: 1003929001
Provider Name: PRAIRIE STAR FAMILY PRACTICE, P.A.
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 17D1034724

Address:
1210 N. WASHINGTON, CLINIC B
PLAINVILLE, KS
ZIP 67663
Phone: (785) 434-2622
Get Directions

PRAIRIE STAR FAMILY PRACTICE, P.A. is a family medicine in Plainville, KS. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PRAIRIE STAR FAMILY PRACTICE, P.A. NPI is 1003929001. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1210 N. WASHINGTON, CLINIC B
PLAINVILLE, KS
ZIP 67663-632
Phone: (785) 434-2622
Fax: (785) 434-2577

The provider's authorized official is Jennifer Brull .
The authorized official title is Owner/president and has the following contact phone number (785) 434-2622.

The CLIA number assigned to this NPI record is 17D1034724 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2006 and was last updated on 6/15/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		04-28262	KANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H26194	MEDICARE UPIN	KANSAS
2	662541	OTHER	KANSAS	FIRSTGUARD #
3	110760	OTHER	KANSAS	BC/BS GROUP
4	101898	OTHER	KANSAS	BC/BS INDIVIDUAL
5	101898	MEDICARE ID-TYPE UNSPECIFIED	KANSAS	MEDICARE INDIVIDUAL
6	110760	MEDICARE ID-TYPE UNSPECIFIED	KANSAS	MEDICARE GROUP
7	100376880C	MEDICAID	KANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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