Great Bend Childrens Clinic PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

GREAT BEND CHILDRENS CLINIC PA

Practice address

1021 Eisenhower Ave
Great Bend Children'S Clinic
Great Bend, KS 67530-3213

Phone

(620) 792-5437

Fax

(620) 793-5245

NPI assigned

Jan 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John T. Edmonds

Title

Practice Administrator

Phone

(620) 792-5437

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marta J Edmonds, M.D.

  • Pediatrics Physician
  • Great Bend, KS
  • NPI 1669450847
  NPD
• Ryan M Williams, M.D.

  • Pediatrics Physician
  • Great Bend, KS
  • NPI 1730167842
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286841600000",
    "number": "1619955853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 EISENHOWER AVE",
            "address_2": "GREAT BEND CHILDREN'S CLINIC",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303213",
            "telephone_number": "620-792-5437",
            "fax_number": "620-793-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 EISENHOWER AVE",
            "address_2": "GREAT BEND CHILDREN'S CLINIC",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303213",
            "telephone_number": "620-792-5437",
            "fax_number": "620-793-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT BEND CHILDRENS CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2010-10-12",
        "status": "A",
        "authorized_official_last_name": "EDMONDS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "620-792-5437"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100127410B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100299730A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NO",
            "identifier": "016773",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Ann Gleason, APRN
• David M. Gonzales, O.T.
• Felicia Renee Gonzalez, RBT
• Carole J Gray, LSCSW AAPS KCGC
• Deanna Gray, LBSW
• Great Bend Homestead Assisted Living, LLC
• Great Bend Regional Hospital LLC
• Great Bend Regional Hospital LLC
• Great Bend Regional Hospital, LLC
• Great Bend Regional Hospital, LLC

• Rural Health Clinic/Center in Great Bend, KS
• Providers in Great Bend, KS by specialty
• Rural Health Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.