Healthcare Provider Details

I. General information

NPI: 1134326929
Provider Name (Legal Business Name): CENTRAL KANSAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 BROADWAY AVE SUITE 121
GREAT BEND KS
67530-3633
US

IV. Provider business mailing address

PO BOX 309
GREAT BEND KS
67530-0309
US

V. Phone/Fax

Practice location:
  • Phone: 620-793-5510
  • Fax: 620-793-5601
Mailing address:
  • Phone: 620-786-6475
  • Fax: 620-786-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SHARON L. LIND
Title or Position: CEO
Credential:
Phone: 620-786-6101