Healthcare Provider Details

I. General information

NPI: 1184739443
Provider Name (Legal Business Name): HEART OF KANSAS FAMILY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 19TH ST
GREAT BEND KS
67530-2502
US

IV. Provider business mailing address

1905 19TH ST
GREAT BEND KS
67530-2502
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5700
  • Fax: 855-463-0851
Mailing address:
  • Phone: 620-792-5700
  • Fax: 855-463-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDDY GUNN
Title or Position: CFO
Credential:
Phone: 620-792-5700