Healthcare Provider Details

I. General information

NPI: 1922340223
Provider Name (Legal Business Name): CENTRAL CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 CLEVELAND ST
GREAT BEND KS
67530-3563
US

IV. Provider business mailing address

PO BOX 256
SALINA KS
67402-0256
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5511
  • Fax: 620-792-5977
Mailing address:
  • Phone: 785-823-0633
  • Fax: 785-823-0658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number0424425
License Number StateKS

VIII. Authorized Official

Name: CANDICE EVANS
Title or Position: CREDENTIALING
Credential:
Phone: 620-603-8846