Great Bend Regional Hospital LLC
Organization Active NPI Family Medicine Physician · Great Bend, KS
NPI 1811234818 · NPPES record last updated Feb 12, 2013
Key facts
- NPI
- 1811234818
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- GREAT BEND REGIONAL HOSPITAL LLC
- Practice address
- 1309 Polk
Great Bend, KS 67530 - Phone
- (620) 792-5341
- Fax
- (620) 792-3702
- NPI assigned
- Jan 10, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- GREAT BEND REGIONAL HOSPITAL, LLC
Authorized official
- Name
- Perry Milton Smith, MD
- Title
- Medical Director
- Phone
- (620) 792-5341
Change of ownership 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Aug 1, 2018 | Change of Ownership |
St. Rose Medical Pavilion |
National Provider Directory
- Part of
- Great Bend Regional Hospital LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | KS | Yes |
Addresses
Primary practice location
1309 Polk
Great Bend, KS 67530
Mailing address
1309 Polk
Great Bend, KS 67530
Phone (620) 792-5341
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100088870A | Medicaid | KS |
Other names
- Central Kansas Family Practice
Other providers in Great Bend, KS
- Carole J Gray
- Deanna Gray
- Great Bend Childrens Clinic PA
- 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
- Great Bend Regional Hospital, LLC
- Great Bend SNF, LLC
All providers in Great Bend, KS · Family Medicine Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.