Provider Demographics
NPI:1225040256
Name:GREAT PLAINS OF ELLINWOOD INC.
Entity Type:Organization
Organization Name:GREAT PLAINS OF ELLINWOOD INC.
Other - Org Name:ELLINWOOD HOSPITAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KILE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-564-2548
Mailing Address - Street 1:611 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-1440
Mailing Address - Country:US
Mailing Address - Phone:620-564-3771
Mailing Address - Fax:620-564-2684
Practice Address - Street 1:605 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-1440
Practice Address - Country:US
Practice Address - Phone:620-564-3771
Practice Address - Fax:620-564-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110746OtherBLUE CROSS
KS000964OtherBCBS 2NDRY FOR RHC
KS1000410070BMedicaid
KS110746OtherMEDICARE PTAN
KS173402OtherMEDICARE PTAN