Organization
CENTRAL KANSAS ANESTHESIA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID GILLENWATER MD (PRESIDENT)
(620) 792-2511
Entity
Organization
Contact information
Practice address
3515 BROADWAY AVE, GREAT BEND, KS 67530-3633
(620) 792-2511
Mailing address
PO BOX 1591, GREAT BEND, KS 67530-1591
(316) 685-6112
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016712
BCBS
KS
01
—
CS1530
RAILROAD MEDICARE
—
Enumeration date
03/09/2006
Last updated
09/11/2025
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