| Prairiestar Health Center, Inc | |
|
2700 E 30th Ave Hutchinson KS 67502 | |
| (620) 663-8484 | |
| (620) 802-0690 |
| Full Name | Prairiestar Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2700 E 30th Ave, Hutchinson, Kansas |
| Authorized Official Name and Position | Justin Bryant Anderson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6206638484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairiestar Health Center, Inc 2700 E 30th Ave Hutchinson KS 67502-1242 Ph: (620) 663-8484 | Prairiestar Health Center, Inc 2700 E 30th Ave Hutchinson KS 67502 Ph: (620) 663-8484 |
| NPI Number | 1871564534 |
|---|---|
| Provider Enumeration Date | 01/31/2006 |
| Last Update Date | 07/02/2018 |
| Medicare PECOS PAC ID | 6305822560 |
|---|---|
| Medicare Enrollment ID | O20040628001010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871564534 | NPI | - | NPPES |
| 110056 | Other | KANSAS BLUE CROSS BS | |
| 100175060B | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Kansas) | Primary |
| Provider Name | James L Pyle |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1508962150 PECOS PAC ID: 3173522646 Enrollment ID: I20061211000223 |
| Provider Name | Brent A Wichert |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1104105204 PECOS PAC ID: 3173797701 Enrollment ID: I20111117000228 |
| Provider Name | Douglas Moore |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1417121492 PECOS PAC ID: 3375681851 Enrollment ID: I20130318000228 |
| Provider Name | Stefanie M Kempke |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1982832432 PECOS PAC ID: 5395992424 Enrollment ID: I20130802000746 |
| Provider Name | Belinda G Bagby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083042956 PECOS PAC ID: 0648409300 Enrollment ID: I20140129002095 |
| Provider Name | Joel Kennedy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629491790 PECOS PAC ID: 8325278427 Enrollment ID: I20140312000839 |
| Provider Name | Clarice M Nelson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811251259 PECOS PAC ID: 6002118585 Enrollment ID: I20151230002328 |
| Provider Name | Miranda L Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487025714 PECOS PAC ID: 3870896178 Enrollment ID: I20160120001795 |
| Provider Name | Brandi M Wiens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962848085 PECOS PAC ID: 7012158629 Enrollment ID: I20160823001107 |
| Provider Name | Cecilia M Hinton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235668070 PECOS PAC ID: 8224309554 Enrollment ID: I20181017003221 |
| Provider Name | Kariann Banning |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558915462 PECOS PAC ID: 2264581115 Enrollment ID: I20191210003348 |
| Provider Name | Raymond Penner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073749982 PECOS PAC ID: 7618388083 Enrollment ID: I20201117000632 |
| Provider Name | Nathan R Knight |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659944866 PECOS PAC ID: 5395141543 Enrollment ID: I20210914000210 |
| Provider Name | Victoria L Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730882531 PECOS PAC ID: 7012373889 Enrollment ID: I20230520000191 |
| Provider Name | Jamie R Burns |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316043078 PECOS PAC ID: 9436594348 Enrollment ID: I20240301002238 |
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