Organization
PRAIRIE BAND POTAWATOMI NATION
Active
Other names
Potawatomi Tribal Fire Department
Organization subpart
No
Provider details
NPI number
Authorized official
LIANA ONNEN (TRIBAL CHAIRPERSON)
(785) 966-4007
Entity
Organization
Contact information
Practice address
15468 K RD, MAYETTA, KS 66509-9093
(785) 966-2164
Mailing address
15482 K RD, MAYETTA, KS 66509-9093
(785) 966-2164
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
1555
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100416330A
—
KS
01
—
112020
BLUE CROSS/BLUE SHIELD
KS
Enumeration date
05/19/2006
Last updated
07/20/2017
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