Healthcare Provider Details

I. General information

NPI: 1487749602
Provider Name (Legal Business Name): GREAT PLAINS OF ELLINWOOD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N PARK AVE
ELLINWOOD KS
67526-1452
US

IV. Provider business mailing address

300 N PARK AVE
ELLINWOOD KS
67526-1452
US

V. Phone/Fax

Practice location:
  • Phone: 620-564-2548
  • Fax: 620-564-2491
Mailing address:
  • Phone: 620-564-2548
  • Fax: 620-564-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberH005001
License Number StateKS

VIII. Authorized Official

Name: MR. KILE MAGNER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 620-564-2548