Organization
GREAT BEND CHILDRENS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T. EDMONDS (PRACTICE ADMINISTRATOR)
(620) 792-5437
Entity
Organization
Contact information
Practice address
1021 EISENHOWER AVE, GREAT BEND CHILDREN'S CLINIC, GREAT BEND, KS 67530-3213
(620) 792-5437
(620) 793-5245
Mailing address
1021 EISENHOWER AVE, GREAT BEND CHILDREN'S CLINIC, GREAT BEND, KS 67530-3213
(620) 792-5437
(620) 793-5245
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016773
BCBS GROUP NO
KS
05
—
100127410B
—
KS
05
—
100299730A
—
KS
Enumeration date
01/06/2006
Last updated
10/12/2010
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