Active NPI
St Rose Health Center Inc
- Internal Medicine Physician
- Great Bend, KS
National Provider Identifier
1619372000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- ST ROSE HEALTH CENTER INC
- Practice address
- 3515 Broadway Ave
Great Bend, KS 67530-3633 - Phone
- (620) 793-8429
- Fax
- (620) 793-6014
- NPI assigned
- Oct 28, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John B Moore
- Title
- Exec Director of Physician Practice
- Phone
- (785) 623-2185
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
3515 Broadway Ave
Great Bend, KS 67530-3633
Mailing address
3515 Broadway Ave
Great Bend, KS 67530-3633
Phone (620) 793-8429
Other names 1
- Great Bend Internists
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414454400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1486425600000",
"number": "1619372000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3515 BROADWAY AVE",
"city": "GREAT BEND",
"state": "KS",
"postal_code": "675303633",
"telephone_number": "620-793-8429",
"fax_number": "620-793-6014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3515 BROADWAY AVE",
"city": "GREAT BEND",
"state": "KS",
"postal_code": "675303633",
"telephone_number": "620-793-8429",
"fax_number": "620-793-6014"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST ROSE HEALTH CENTER INC",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-28",
"last_updated": "2017-02-07",
"status": "A",
"authorized_official_last_name": "MOORE",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "EXEC DIRECTOR OF PHYSICIAN PRACTICE",
"authorized_official_telephone_number": "785-623-2185"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Great Bend Internists",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Great Bend, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.