Provider Demographics
NPI:1366469371
Name:CENTRAL KANSAS MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL KANSAS MEDICAL CENTER
Other - Org Name:GOLDEN BELT HOME HEALTH AND HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-792-8171
Mailing Address - Street 1:3520 LAKIN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3646
Mailing Address - Country:US
Mailing Address - Phone:620-792-8171
Mailing Address - Fax:620-792-3825
Practice Address - Street 1:3520 LAKIN
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3646
Practice Address - Country:US
Practice Address - Phone:620-792-8171
Practice Address - Fax:620-792-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-005-006251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100069640BMedicaid
KS763OtherBCBS
KS763OtherBCBS