NPIMap

Organization Active NPI

Great Bend Regional Hospital, LLC

  • Clinical Medical Laboratory
  • Great Bend, KS
National Provider Identifier
1780922773
Registry record updated Mar 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
17D0452731 Issued in KS
Legal business name
GREAT BEND REGIONAL HOSPITAL, LLC
Practice address
1309 Polk St
Great Bend, KS 67530-3644
Phone
(620) 792-4266
Fax
(620) 792-2665
NPI assigned
Jan 25, 2013
Organization subpart
Yes
Parent organization
GREAT BEND REGIONAL HOSPITAL, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 10, 2016

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

Authorized official

Name
Mr. Robert E Baum
Title
Administrator
Phone
(620) 792-5341

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 106062 KS
Clinical Medical Laboratory 291U00000X 17D0452731 KS Primary

Addresses

Primary practice location

1309 Polk St
Great Bend, KS 67530-3644

Mailing address

1309 Polk St
Great Bend, KS 67530
Phone (620) 792-5404

Other names 1

  • Central Kansas Medical Park Ancillary Service Doing business as

National Provider Directory

National Provider Directory
Part of
Great Bend Regional Hospital LLC

Practitioners & affiliated clinicians

Practitioners 3

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": "1359072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1780922773",
    "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": "67530",
            "telephone_number": "620-792-5404",
            "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": "675303644",
            "telephone_number": "620-792-4266",
            "fax_number": "620-792-2665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT BEND REGIONAL HOSPITAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT BEND REGIONAL HOSPITAL, LLC",
        "enumeration_date": "2013-01-25",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "BAUM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "620-792-5341",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KS",
            "license": "106062",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "KS",
            "license": "17D0452731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Kansas Medical Park Ancillary Service",
            "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 Mar 10, 2016; 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.