Organization · NPI-2

Prairie Star Family Practice, P.A.

Family Medicine · Plainville, KS

NPI number1003929001
StatusActive
Last updated in NPPESJun 15, 2010

Details

NPI
1003929001
Entity type
Organization (NPI-2)
Legal business name
Prairie Star Family Practice, P.A.
Organization subpart
No
Enumeration date
Aug 16, 2006
Last updated
Jun 15, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine04-28262KSYes

Practice location

1210 N. Washington, Clinic B
Plainville, KS 67663-1632

Phone 785-434-2622 · Fax 785-434-2577

Mailing address

1210 N. Washington, Clinic B
P.O. Box 407
Plainville, KS 67663-0407

Phone 785-434-2622 · Fax 785-434-2577

Authorized official

Jennifer Brull
Owner/President
7854342622

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