Healthcare Provider Details

I. General information

NPI: 1992023907
Provider Name (Legal Business Name): GREAT PLAINS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ASHLAND ST
NEVADA MO
64772-1710
US

IV. Provider business mailing address

1500 W ASHLAND ST
NEVADA MO
64772-1710
US

V. Phone/Fax

Practice location:
  • Phone: 417-448-5602
  • Fax: 417-448-5688
Mailing address:
  • Phone: 417-448-5602
  • Fax: 417-448-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number000076966
License Number StateMO

VIII. Authorized Official

Name: STEVGE FILTON
Title or Position: SR VP CFO
Credential:
Phone: 610-768-3300