Healthcare Provider Details

I. General information

NPI: 1588150635
Provider Name (Legal Business Name): UKHS GREAT BEND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 EISENHOWER AVE
GREAT BEND KS
67530-3213
US

IV. Provider business mailing address

1021 EISENHOWER AVE
GREAT BEND KS
67530-3213
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-2511
  • Fax:
Mailing address:
  • Phone: 620-792-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSE MOCK
Title or Position: CEO
Credential:
Phone: 620-791-6272