| |
410 Cheyenne Satanta KS 67870-8748 | |
(620) 649-2771 | |
(620) 649-2538 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 410 Cheyenne, Satanta, Kansas |
Authorized Official Name and Position | Jeremy Clingenpeel (ADMINISTRATOR) |
Authorized Official Contact | 6206492761 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
401 Cheyenne Satanta KS 67870-0159 Ph: (620) 649-2771 | 410 Cheyenne Satanta KS 67870-8748 Ph: (620) 649-2771 |
NPI Number | 1316999246 |
---|---|
Provider Enumeration Date | 05/17/2006 |
Last Update Date | 05/09/2014 |
Medicare PECOS PAC ID | 5991616054 |
---|---|
Medicare Enrollment ID | O20030919000032 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316999246 | NPI | - | NPPES |
OO1326 | Other | KS | BLUE CROSS # |
100080490B | Medicaid | KS | |
100262240A | Medicaid | KS |