# ST. ROSE HEALTH CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366847808
- **Authorized official:** DR. JOHN H JETER M.D. (PRESIDENT)
- **Authorized official phone:** (785) 623-5523

## Contact information

- **Practice address:** 3515 BROADWAY AVE, GREAT BEND, KS 67530-3633
- **Practice address phone:** (620) 792-2511
- **Mailing address:** 3515 BROADWAY AVE, GREAT BEND, KS 67530-3633

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/27/2014
- **Last updated:** 10/27/2014