Healthcare Provider Details

I. General information

NPI: 1982644936
Provider Name (Legal Business Name): GREAT PLAINS OF CHEYENNE CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W FIRST
SAINT FRANCIS KS
67756-1075
US

IV. Provider business mailing address

221 W FIRST PO BOX 1075
SAINT FRANCIS KS
67756-1075
US

V. Phone/Fax

Practice location:
  • Phone: 785-332-2682
  • Fax: 785-332-2516
Mailing address:
  • Phone: 785-332-2682
  • Fax: 785-332-2516

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: JEREMY MICHAEL CLINGENPEEL
Title or Position: CEO
Credential:
Phone: 785-332-2104