Healthcare Provider Details

I. General information

NPI: 1881927382
Provider Name (Legal Business Name): CENTRAL KANSAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 BROADWAY AVE SUITE 109
GREAT BEND KS
67530-3633
US

IV. Provider business mailing address

PO BOX D
GREAT BEND KS
67530-8004
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-6699
  • Fax: 620-786-6581
Mailing address:
  • Phone: 620-786-6475
  • Fax: 620-786-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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