PRAIRIE BAND POTAWATOMI NATION (NPI# 1952323958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952323958 |
| Entity Type | Organization |
| Organization Name | PRAIRIE BAND POTAWATOMI NATION |
| Practice Address |
11400 158th Rd Mayetta KS 66509-8866 |
| Mailing Address |
11400 158th Rd Mayetta KS 66509-0249 |
| Practice Telephone | 8667276330 |
| Practice Fax Number | 7859668396 |
| Mailing Telephone | 7859668200 |
| Mailing Fax Number | 7859668396 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2018-01-23 |
| Authorized Official Name | MIKE CARPENTER (CHIEF PHARMACIST) |
| Authorized Official Telephone | 7859668266 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | Y |
| Parent Organization Name | PRAIRIE BAND POTAWATOMI NATION |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2-2546 | KS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2027266 | 01 | |
| KS | 200259300B | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245266410 | Prairie Band Potawatomi Nation | Clinic/Center | 11400 158th Rd, Mayetta, KS 66509-0249 | 2006-06-22 |
| 1174577738 | Prairie Band Potawatomi Nation | Ambulance | 15468 K Rd, Mayetta, KS 66509-9093 | 2006-05-19 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PRAIRIE BAND POTAWATOMI NATION | 16281 Q Rd, Mayetta, KS 66509-8970 |
| Street Address |
11400 158TH RD |
| City | MAYETTA |
| State | KS |
| Zip Code | 66509-8866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245266410 | Prairie Band Potawatomi Nation | Clinic/Center | 11400 158th Rd, Mayetta, KS 66509-0249 | 2006-06-22 |
| 1679060776 | Edith Wamego | Behavior Technician | 11400 158th Rd, Mayetta, KS 66509-8866 | 2018-04-16 |
| 1326499955 | Brendan Michael Handy | Pharmacist | 11400 158th Rd, Mayetta, KS 66509-8866 | 2016-06-24 |
| 1053761668 | Charles G Beals | Dentist | 11400 158th Rd, Mayetta, KS 66509 | 2016-06-14 |
| 1558760983 | Walter Anthony Siebert | Social Worker | 11400 158th Rd, Mayetta, KS 66509-8866 | 2014-08-21 |
| 1992973218 | Mary Melinda Boren | Registered Nurse | 11400 158th Rd, Mayetta, KS 66509-8866 | 2008-02-20 |
| 1346467230 | James S Bear Jr. | Family Medicine | 11400 158th Rd, Mayetta, KS 66509-8866 | 2007-04-20 |
| 1063582443 | Randy J German | Dentist | 11400 158th Rd, Mayetta, KS 66509 | 2006-11-09 |
| 1427132612 | Nola Ahlquist-turner | Nurse Practitioner | 11400 158th Rd, Mayetta, KS 66509-8866 | 2006-10-24 |
| 1881625721 | Terry Lee Harter | Family Medicine | 11400 158th Rd, Mayetta, KS 66509-8866 | 2006-07-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508286113 | Mendy Lynn Thompson | Counselor | 11400 158th Road, Mayetta, KS 66509 | 2014-04-22 |
| 1699042010 | Cindy Kelly | Social Worker | 11400 158 Road, Mayetta, KS 66509 | 2011-11-30 |
| 1932306883 | Independent Anesthesia Services, LLC | Nurse Anesthetist, Certified Registered | 14395 Hwy 75, Mayetta, KS 66509 | 2007-07-02 |
| 1851313050 | Royal Valley Usd 337 | Local Education Agency (LEA) | 101 W Main, Mayetta, KS 66509 | 2006-07-24 |
| 1679993018 | Norman David Arnold | Counselor | 11400 158th Rd., Mayetta, KS 66509-0174 | 2014-04-24 |
| 1043630650 | Elaine Mzhickteno Barr | Counselor | 11400 - 158th Road, Mayetta, KS 66509-0174 | 2014-04-22 |
| 1093037426 | Royal Valley | Local Education Agency (LEA) | 101 W Main, Mayetta, KS 66509-0219 | 2010-02-26 |
| 1104806637 | Nancy H Noble | Family Medicine | 15419 154th Rd, Mayetta, KS 66509-8715 | 2006-01-19 |
| 1023382215 | Toby Edward Leavendusky | Registered Nurse | 16809 R Rd, Mayetta, KS 66509-8954 | 2012-03-06 |
| 1174577738 | Prairie Band Potawatomi Nation | Ambulance | 15468 K Rd, Mayetta, KS 66509-9093 | 2006-05-19 |
| Find all providers in zip 66509 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801058748 | Kickapoo Nation Health Center | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 1117 Goldfinch Road, Horton, KS 66439 | 2008-07-01 |
| 1275683369 | White Cloud Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 3313 Thrasher Rd, White Cloud, KS 66094-4028 | 2007-01-11 |
| 1194288480 | White Cloud Health Center, LLC | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 3349b Thrasher Rd, White Cloud, KS 66094-4005 | 2019-04-12 |
| 1326198581 | Haskell Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 2415 Massachusetts St, Lawrence, KS 66046-4827 | 2007-01-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.