Basic Information
| Provider Information | |||||||||
| NPI: | 1275580524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAWNEE MENTAL HEALTH SERVICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 CLAFLIN RD | ||||||||
| Address2: | PO BOX 747 | ||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
| FaxNumber: | 7855874377 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 CLAFLIN RD | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665023415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855874300 | ||||||||
| FaxNumber: | 7855874377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | HANSON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7855874300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | KS | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 100098030B | 05 | KS | MEDICAID | 100098030D | 05 | KS | MEDICAID | 100098030A | 05 | KS | MEDICAID | 100098030C | 05 | KS | MEDICAID | 100098030F | 05 | KS | MEDICAID | 100098030E | 05 | KS | MEDICAID | 100098030X | 05 | KS | MEDICAID |