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Ukhs Great Bend, LLC

Organization Active NPI General Acute Care Hospital · Great Bend, KS

NPI 1669962593 · NPPES record last updated Mar 11, 2020

Key facts

NPI
1669962593
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
Legal business name
UKHS GREAT BEND, LLC
Practice address
514 Cleveland St
Great Bend, KS 67530
Phone
(620) 792-8833
NPI assigned
May 16, 2018
Organization subpart
No

Authorized official

Name
Jesse Mock
Title
Authorized Official
Phone
(620) 791-6272

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 64

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

View all 64

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KS

Hospital certification: CCN 17U191

Legal name
UKHS GREAT BEND LLC
Doing business as
THE UNIVERSITY OF KANSAS HEALTH SYSTEM GREAT BEND CAMPUS
Organization structure
LLC · Proprietary
Incorporated
May 8, 2018 in KS
Enrollment address
514 Cleveland St
Great Bend, KS 67530-3562
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Timothy a Latimer
Individual 		Corporate Director
Director of Finance/Controller		 Aug 1, 2018 5%
Operational/Managerial Control
Director of Finance/Controller		 Aug 1, 2018 5%
Catherine R Wiens
Individual 		Corporate Officer Sep 1, 2023
John Worden
Individual 		Corporate Officer Sep 1, 2023
Operational/Managerial Control Sep 1, 2023
Daniel Peters
Individual 		Corporate Officer Sep 1, 2023
University of Kansas Hospital Authority
Organization · Kansas City, KS
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Aug 1, 2018 99.9%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20181002001027 KS Part a Provider - Hospital 5597016378 Practice locations: Great Bend, KS

National Provider Directory

Tax ID family
Ukhs Great Bend LLC (11 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Yes

Addresses

Primary practice location

514 Cleveland St
Great Bend, KS 67530

Mailing address

514 Cleveland St
Great Bend, KS 67530-3562
Phone (620) 792-8833

Other names

  • The University of Kansas Health System Great Bend Campus Doing business as

Other providers in Great Bend, KS

All providers in Great Bend, KS · General Acute Care Hospital in Kansas

Sources for this page

Verify at the official NPI Registry.