Provider Demographics
NPI:1306059662
Name:PRAIRIE VIEW, INC.
Entity type:Organization
Organization Name:PRAIRIE VIEW, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-284-6400
Mailing Address - Street 1:P.O. BOX 467
Mailing Address - Street 2:1901 E. 1ST ST.
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0467
Mailing Address - Country:US
Mailing Address - Phone:316-284-6400
Mailing Address - Fax:316-284-6491
Practice Address - Street 1:508 S. ASH
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-0185
Practice Address - Country:US
Practice Address - Phone:620-947-3200
Practice Address - Fax:620-947-3845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRAIRIE VIEW, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 283Q00000X
KS002107142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100005670LMedicaid
KS003764Medicare PIN