Organization
COUNTY OF PRATT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DARCIE LEA VAN DER VYVER RN (ADMINISTRATOR)
(620) 672-4135
Entity
Organization
Contact information
Practice address
712 S MAIN ST, PRATT, KS 67124-2631
(620) 672-4135
(620) 672-1129
Mailing address
712 S MAIN ST, PRATT, KS 67124-2631
(620) 672-4135
(620) 672-1129
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012762
BLUE CROSS BLUE SHIELD
KS
05
—
100092100A
—
KS
05
—
100092100D
—
KS
01
—
629450
FIRSTGUARD
—
Enumeration date
07/09/2006
Last updated
10/26/2022
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