# UKHS GREAT BEND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UKHS Great Bend St. Rose Pavilion, UKHS St. Rose Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992272918
- **Authorized official:** JESSE MOCK (CEO)
- **Authorized official phone:** (620) 791-6272

## Contact information

- **Practice address:** 3515 BROADWAY AVE, GREAT BEND, KS 67530-3633
- **Practice address phone:** (620) 786-6163
- **Practice address fax:** (620) 786-6298
- **Mailing address:** 3515 BROADWAY AVE, GREAT BEND, KS 67530-3633
- **Mailing address phone:** (620) 786-6163
- **Mailing address fax:** (620) 786-6298

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 10/29/2018
- **Last updated:** 03/11/2020