Healthcare Provider Details

I. General information

NPI: 1932122215
Provider Name (Legal Business Name): GREAT PLAINS OF REPUBLIC CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 G ST
BELLEVILLE KS
66935-2400
US

IV. Provider business mailing address

2420 G ST
BELLEVILLE KS
66935-2400
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-2254
  • Fax: 785-527-2800
Mailing address:
  • Phone: 785-527-2254
  • Fax: 785-527-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID-PAUL CAVAZOS
Title or Position: ADMINISTRATOR
Credential:
Phone: 785-527-6000