Provider Demographics
NPI:1275828634
Name:CENTRAL KANSAS MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL KANSAS MEDICAL CENTER
Other - Org Name:ST. ROSE SLEEP-WAKE DISORDERS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEDDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-786-6643
Mailing Address - Street 1:3515 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3633
Mailing Address - Country:US
Mailing Address - Phone:620-786-6101
Mailing Address - Fax:620-786-6298
Practice Address - Street 1:3515 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3633
Practice Address - Country:US
Practice Address - Phone:620-786-6101
Practice Address - Fax:620-786-6298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC HEALTH INITIATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic