Organization
PRAIRIE BAND POTAWATOMI NATION
Active
Other names
Prairie Band Potawatomi Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY LEWIS (BUSINESS OFFICE MANAGER)
(785) 966-8282
Entity
Organization
Contact information
Practice address
11400 158TH RD, MAYETTA, KS 66509-0249
(785) 966-8200
(785) 966-8393
Mailing address
11400 158TH RD, MAYETTA, KS 66509-0249
(785) 966-8200
(785) 966-8393
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200259300A
—
KS
Enumeration date
06/22/2006
Last updated
07/21/2022
Update your record
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