NPIMap

Organization Active NPI

Ukhs Great Bend, LLC

Doing business as UKHS Great Bend St. Rose Pavilion

  • General Practice Physician
  • Great Bend, KS
National Provider Identifier
1992272918
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
UKHS GREAT BEND, LLC
Doing business as
UKHS Great Bend St. Rose Pavilion
UKHS St. Rose Health Center
Practice address
3515 Broadway Ave
Great Bend, KS 67530-3633
Phone
(620) 786-6163
Fax
(620) 786-6298
NPI assigned
Oct 29, 2018
Last updated
Mar 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Authorized official

Name
Jesse Mock
Title
Ceo
Phone
(620) 791-6272

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X
General Practice Physician 208D00000X Primary
Physical Therapist 225100000X

Addresses

Primary practice location

3515 Broadway Ave
Great Bend, KS 67530-3633

Mailing address

3515 Broadway Ave
Great Bend, KS 67530-3633
Phone (620) 786-6163

Other names 2

  • UKHS Great Bend St. Rose Pavilion Doing business as
  • UKHS St. Rose Health Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ukhs Great Bend LLC11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

NPI Registry JSON

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

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1992272918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 BROADWAY AVE",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303633",
            "telephone_number": "620-786-6163",
            "fax_number": "620-786-6298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 BROADWAY AVE",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303633",
            "telephone_number": "620-786-6163",
            "fax_number": "620-786-6298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UKHS GREAT BEND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-29",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "MOCK",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "620-791-6272"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UKHS Great Bend St. Rose Pavilion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UKHS St. Rose Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UKHS St. Rose Health Center",
            "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 11, 2020; 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.