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410 Cheyenne Street Satanta KS 67870-0009 | |
(620) 649-2771 | |
(620) 649-2538 |
Full Name | |
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Speciality | Family Medicine |
Location | 410 Cheyenne Street, Satanta, Kansas |
Authorized Official Name and Position | Tina Pendergraft (ADMINISTRATOR) |
Authorized Official Contact | 6206492761 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 9 Satanta KS 67870-0009 Ph: (620) 649-2771 | 410 Cheyenne Street Satanta KS 67870-0009 Ph: (620) 649-2771 |
NPI Number | 1144312844 |
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Provider Enumeration Date | 09/29/2006 |
Last Update Date | 01/27/2021 |
Medicare PECOS PAC ID | 5991616054 |
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Medicare Enrollment ID | O20040311001369 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144312844 | NPI | - | NPPES |
110220 | Other | KS | NON RURAL HEALTH NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H041001 (Kansas) | Primary |
208VP0014X | Pain Medicine - Interventional Pain Medicine | (* (Not Available)) | Secondary |
Provider Name | Amy R Nightengale |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306876933 PECOS PAC ID: 8325072663 Enrollment ID: I20050926000506 |
Provider Name | Peggy A Parker |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497192439 PECOS PAC ID: 1850535329 Enrollment ID: I20130924000116 |
Provider Name | Jason L Hoke |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1992969661 PECOS PAC ID: 6507196300 Enrollment ID: I20190920001972 |
Provider Name | Anjali Giri |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1437765013 PECOS PAC ID: 8921404807 Enrollment ID: I20210831003366 |
Provider Name | Henry Derbes |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1912434978 PECOS PAC ID: 7911389622 Enrollment ID: I20240610001907 |