Healthcare Provider Details

I. General information

NPI: 1255856258
Provider Name (Legal Business Name): HEART OF KANSAS FAMILY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 GRAND AVE
STAFFORD KS
67578-2010
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:
Mailing address:
  • Phone: 620-792-5700
  • Fax: 620-792-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JYL NOKES
Title or Position: CO
Credential:
Phone: 620-792-5700