NPIMap

Organization Active NPI

Central Kansas Medical Park Ancillary Services, P.a.

  • Clinical Medical Laboratory
  • Great Bend, KS
National Provider Identifier
1710988134
Registry record updated Apr 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CENTRAL KANSAS MEDICAL PARK ANCILLARY SERVICES, P.A.
Practice address
1309 Polk St
Great Bend, KS 67530-3618
Phone
(620) 793-5404
Fax
(620) 792-2665
NPI assigned
Aug 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2013

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

Authorized official

Name
Perry M Smith, M.D.
Title
President
Phone
(620) 793-5404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

1309 Polk St
Great Bend, KS 67530-3618

Mailing address

1309 Polk St
Great Bend, KS 67530-3618
Phone (620) 793-5404

Other identifiers 2

IdentifierTypeStateIssuer
016144OtherKSBLUE SHIELD
100245710AMedicaidKS

National Provider Directory

National Provider Directory

Locations

1309 Polk St
Great Bend, KS 67530
Phone (620) 792-5341

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364774400000",
    "number": "1710988134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1309 POLK ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303618",
            "telephone_number": "620-793-5404",
            "fax_number": "620-792-2665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 POLK ST",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303618",
            "telephone_number": "620-793-5404",
            "fax_number": "620-792-2665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL KANSAS MEDICAL PARK ANCILLARY SERVICES, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2013-04-01",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PERRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "620-793-5404",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "016144",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100245710A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 1, 2013; 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.