Provider Demographics
NPI:1295022358
Name:CENTRAL KANSAS MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL KANSAS MEDICAL CENTER
Other - Org Name:ST ROSE PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP/SITE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRSIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-786-6163
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:620-792-2511
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:620-792-2511
Practice Address - Fax:620-786-6298
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL KANSAS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-08
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty