# GREAT PLAINS OF REPUBLIC CO., INC.

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

## Provider details

- **NPI number:** 1932122215
- **Authorized official:** DAVID-PAUL CAVAZOS (ADMINISTRATOR)
- **Authorized official phone:** (785) 527-6000

## Contact information

- **Practice address:** 2420 G ST, BELLEVILLE, KS 66935-2400
- **Practice address phone:** (785) 527-2254
- **Practice address fax:** (785) 527-2800
- **Mailing address:** 2420 G ST, BELLEVILLE, KS 66935-2400
- **Mailing address phone:** (785) 527-2254
- **Mailing address fax:** (785) 527-2800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133V00000X | Registered Dietitian | — | NULL | — |
| 133V00000X | Registered Dietitian | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 07/26/2006
- **Last updated:** 05/14/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 012262 | BLUE SHIELD OF KS | KS |
| 05 | — | 100409140B | — | KS |
| 01 | — | 111088 | BLUE SHIELD OF KANSAS | KS |