Provider Demographics
NPI:1588697783
Name:COUNTY OF PRATT
Entity type:Organization
Organization Name:COUNTY OF PRATT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:VAN DER VYVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-672-4135
Mailing Address - Street 1:712 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2631
Mailing Address - Country:US
Mailing Address - Phone:620-672-4135
Mailing Address - Fax:620-672-1129
Practice Address - Street 1:712 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2631
Practice Address - Country:US
Practice Address - Phone:620-672-4135
Practice Address - Fax:620-672-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS012762OtherBLUE CROSS BLUE SHIELD
KS100092100AMedicaid
KS100092100DMedicaid
629450OtherFIRSTGUARD
KS100092100DMedicaid