=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578676409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT PLAINS OF ELLINWOOD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 07/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N PARK AVE
-----------------------------------------------------
City | ELLINWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67526-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-564-2548
-----------------------------------------------------
Fax | 620-564-2491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 N PARK AVE
-----------------------------------------------------
City | ELLINWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67526-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-564-2548
-----------------------------------------------------
Fax | 620-564-2491
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. KILE MAGNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 620-564-2548
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | H005001
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------