Provider Demographics
NPI:1760405815
Name:GREAT PLAINS OF REPUBLIC CO., INC.
Entity Type:Organization
Organization Name:GREAT PLAINS OF REPUBLIC CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID-PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVAZOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-527-6000
Mailing Address - Street 1:2420 G ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2400
Mailing Address - Country:US
Mailing Address - Phone:785-527-2254
Mailing Address - Fax:785-527-2501
Practice Address - Street 1:2420 G ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2400
Practice Address - Country:US
Practice Address - Phone:785-527-2254
Practice Address - Fax:785-527-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSHO79001275N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Not Answered282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001586OtherKANSAS BLUE CROSS
KS100409140AMedicaid
KS001586OtherKANSAS BLUE CROSS