Organization
UKHS GREAT BEND LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE MOCK (CEO)
(785) 656-9434
Entity
Organization
Contact information
Practice address
3515 BROADWAY AVE, GREAT BEND, KS 67530-3633
(620) 786-6163
Mailing address
3515 BROADWAY AVE, GREAT BEND, KS 67530-3633
(620) 786-6117
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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