Healthcare Provider Details

I. General information

NPI: 1174570386
Provider Name (Legal Business Name): PRATT INTERNAL MEDICINE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 COUNTRY CLUB RD
PRATT KS
67124-3125
US

IV. Provider business mailing address

420 COUNTRY CLUB RD
PRATT KS
67124-3125
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7415
  • Fax: 620-672-7414
Mailing address:
  • Phone: 620-672-7415
  • Fax: 620-672-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL J SUITER
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 620-672-7415