Provider Demographics
NPI:1881634970
Name:CENTRAL KANSAS MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTRAL KANSAS MEDICAL CENTER
Other - Org Name:CENTRAL KANSAS SURGICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-786-6101
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-0989
Mailing Address - Country:US
Mailing Address - Phone:620-786-6475
Mailing Address - Fax:620-786-6155
Practice Address - Street 1:3520 LAKIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3660
Practice Address - Country:US
Practice Address - Phone:620-792-1227
Practice Address - Fax:620-792-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100069640JMedicaid
KS1881634970OtherBCBSKS PIN
KSKA1371Medicare PIN