Provider Demographics
NPI:1760566947
Name:GOVE COUNTY MEDICAL CENTER
Entity Type:Organization
Organization Name:GOVE COUNTY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BERGLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-754-3341
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:520 W 5TH STREET
Mailing Address - City:QUINTER
Mailing Address - State:KS
Mailing Address - Zip Code:67752-0129
Mailing Address - Country:US
Mailing Address - Phone:785-754-3341
Mailing Address - Fax:785-754-3329
Practice Address - Street 1:520 W 5TH STREET
Practice Address - Street 2:
Practice Address - City:QUINTER
Practice Address - State:KS
Practice Address - Zip Code:67752-0129
Practice Address - Country:US
Practice Address - Phone:785-754-3341
Practice Address - Fax:785-754-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH032001207L00000X
KS207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100099330CMedicaid
KS144541OtherBCBS-WERTZ
KS144541OtherBCBS-ANES-WERTZ
KS043289OtherBCBS -ANES-ABBOTT
KS145129OtherBCBS-ANES-SEILER
KS145129OtherBCBS-ANES-SEILER
KS144541OtherBCBS-WERTZ
KS171367Medicare Oscar/Certification