Healthcare Provider Details

I. General information

NPI: 1366469371
Provider Name (Legal Business Name): CENTRAL KANSAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 LAKIN
GREAT BEND KS
67530-3646
US

IV. Provider business mailing address

3520 LAKIN SUITE 102
GREAT BEND KS
67530-3646
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-8171
  • Fax: 620-792-3825
Mailing address:
  • Phone: 620-792-8171
  • Fax: 620-792-3825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA-005-006
License Number StateKS

VIII. Authorized Official

Name: MRS. DONITA WOLF
Title or Position: MANAGER
Credential: RN
Phone: 620-792-8171