Healthcare Provider Details

I. General information

NPI: 1881781136
Provider Name (Legal Business Name): GREAT PLAINS OF CHEYENNE CO. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W FIRST
ST FRANCIS KS
67756-0547
US

IV. Provider business mailing address

210 W FIRST
ST FRANCIS KS
67756-0547
US

V. Phone/Fax

Practice location:
  • Phone: 785-332-2104
  • Fax: 785-332-3255
Mailing address:
  • Phone: 785-332-2104
  • Fax: 785-332-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

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