Provider Demographics
NPI:1720041684
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:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-791-6815
Mailing Address - Street 1:514 CLEVELAND STREET
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3562
Mailing Address - Country:US
Mailing Address - Phone:620-792-8833
Mailing Address - Fax:620-792-1448
Practice Address - Street 1:514 CLEVELAND STREET
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:620-792-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH005004282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001506OtherBCBS
KS0187321801Medicaid
KS0187321801Medicaid