Healthcare Provider Details

I. General information

NPI: 1801042353
Provider Name (Legal Business Name): CENTRAL KANSAS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 LAKIN AVE SUITE 103
GREAT BEND KS
67530-3646
US

IV. Provider business mailing address

3520 LAKIN AVE SUITE 103
GREAT BEND KS
67530-3646
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-3345
  • Fax: 620-792-3767
Mailing address:
  • Phone: 620-792-3767
  • Fax: 620-792-3767

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: LEANNE IRSIK
Title or Position: SR. VP/SITE ADMINISTRATOR
Credential:
Phone: 620-786-6163