Healthcare Provider Details

I. General information

NPI: 1154136612
Provider Name (Legal Business Name): HEART OF KANSAS FAMILY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 18TH ST
GREAT BEND KS
67530-2500
US

IV. Provider business mailing address

1905 19TH ST
GREAT BEND KS
67530-2502
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5700
  • Fax: 620-792-5742
Mailing address:
  • Phone: 620-792-5700
  • Fax: 620-792-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: FREDDY GUNN
Title or Position: CFO
Credential:
Phone: 620-792-5700