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General NPI Number Information
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NPI Number | 1871564534
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Entity Type | Organization
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Legal Business Name | PRAIRIESTAR HEALTH CENTER, INC
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 03/15/2025
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Provider Practice Location Address
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Address Line | 2700 E 30TH AVE
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City | HUTCHINSON
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State | KS
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Zip | 67502
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Country | US
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Telephone | 620-663-8484
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Fax | 620-663-9526
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Provider Business Mailing Address
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Address Line | 2700 E 30TH AVE
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City | HUTCHINSON
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State | KS
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Zip | 67502-1242
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Country | US
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Telephone | 620-663-8484
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Fax | 620-802-0690
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JUSTIN BRYANT ANDERSON
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Credential |
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Telephone | 620-663-8484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | KS
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