Healthcare Provider Details

I. General information

NPI: 1871564534
Provider Name (Legal Business Name): PRAIRIESTAR HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/15/2025
Certification Date: 03/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E 30TH AVE
HUTCHINSON KS
67502
US

IV. Provider business mailing address

2700 E 30TH AVE
HUTCHINSON KS
67502-1242
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-8484
  • Fax: 620-663-9526
Mailing address:
  • Phone: 620-663-8484
  • Fax: 620-802-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateKS

VIII. Authorized Official

Name: MR. JUSTIN BRYANT ANDERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 620-663-8484