Provider Demographics
NPI:1063643112
Name:GREAT BEND REGIONAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:GREAT BEND REGIONAL HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-792-8833
Mailing Address - Street 1:6880 W SNOWVILLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3254
Mailing Address - Country:US
Mailing Address - Phone:440-627-2543
Mailing Address - Fax:
Practice Address - Street 1:514 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3562
Practice Address - Country:US
Practice Address - Phone:620-792-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT BEND REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-06
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100396140BMedicaid
KSKA1609Medicare PIN