NPIMap

Organization Active NPI

Prairie Band Potawatomi Nation

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Mayetta, KS
National Provider Identifier
1952323958
Registry record updated Jan 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
License
2-2546 Issued in KS
Legal business name
PRAIRIE BAND POTAWATOMI NATION
Practice address
11400 158TH Rd
Mayetta, KS 66509-8866
Phone
(866) 727-6330
Fax
(785) 966-8396
NPI assigned
Jul 25, 2006
Last updated
Jan 23, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
PRAIRIE BAND POTAWATOMI NATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Carpenter, RPH
Title
Chief Pharmacist
Phone
(785) 966-8266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X 2-2546 KS Primary

Addresses

Primary practice location

11400 158TH Rd
Mayetta, KS 66509-8866

Mailing address

11400 158TH Rd
Mayetta, KS 66509-0249
Phone (785) 966-8200

Other identifiers 2

IdentifierTypeStateIssuer
200259300BMedicaidKS
2027266OtherPK

National Provider Directory

National Provider Directory
Tax ID family
Prairie Band of Pot Nation3 organizations share this tax ID, including this one
Part of
Prairie Band of Pot Nation

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516665600000",
    "number": "1952323958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 158TH RD",
            "city": "MAYETTA",
            "state": "KS",
            "postal_code": "665090249",
            "telephone_number": "785-966-8200",
            "fax_number": "785-966-8396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 158TH RD",
            "city": "MAYETTA",
            "state": "KS",
            "postal_code": "665098866",
            "telephone_number": "866-727-6330",
            "fax_number": "785-966-8396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE BAND POTAWATOMI NATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRAIRIE BAND POTAWATOMI NATION",
        "enumeration_date": "2006-07-25",
        "last_updated": "2018-01-23",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "785-966-8266",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": "KS",
            "license": "2-2546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200259300B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2027266",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayetta, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.