MEDICARE: HEART OF KANSAS FAMILY HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	101YP2500X	Professional Counselor
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

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

Provider Business Mailing Address
First Line	:	1905 19TH ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-2502
Country	:	US
Telephone Number	:	620-792-5700
Fax Number	:	855-463-0851

Provider Business Practice Location Address
First Line	:	1910 18TH ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-2500
Country	:	US
Telephone Number	:	620-792-5700
Fax Number	:	855-463-0851

Authorized Official
Title or Position	:	CFO
Name	:	FREDDY GUNN
Credential	:
Telephone Number	:	620-792-5700

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	05/08/2026

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