Provider Demographics
NPI:1174570386
Name:PRATT INTERNAL MEDICINE GROUP PA
Entity type:Organization
Organization Name:PRATT INTERNAL MEDICINE GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUITER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-672-7415
Mailing Address - Street 1:420 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3125
Mailing Address - Country:US
Mailing Address - Phone:620-672-7415
Mailing Address - Fax:620-672-7414
Practice Address - Street 1:420 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3125
Practice Address - Country:US
Practice Address - Phone:620-672-7415
Practice Address - Fax:620-672-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100088840BMedicaid
KS000811OtherRURAL HEALTH BLUE CROSS
KS173877Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE
173877Medicare Oscar/Certification