Healthcare Provider Details

I. General information

NPI: 1366223810
Provider Name (Legal Business Name): GREAT PLAINS OF REPUBLIC CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 G ST STE 100
BELLEVILLE KS
66935-2462
US

IV. Provider business mailing address

2337 G ST STE 100
BELLEVILLE KS
66935-2462
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-2217
  • Fax: 785-527-2800
Mailing address:
  • Phone: 785-527-2217
  • Fax: 785-527-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WESLEY GOFORTH
Title or Position: CFO
Credential:
Phone: 785-527-2254