Organization
CENTRAL KANSAS MEDICAL PARK ANCILLARY SERVICES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PERRY M SMITH M.D. (PRESIDENT)
(620) 793-5404
Entity
Organization
Contact information
Practice address
1309 POLK ST, GREAT BEND, KS 67530-3618
(620) 793-5404
(620) 792-2665
Mailing address
1309 POLK ST, GREAT BEND, KS 67530-3618
(620) 793-5404
(620) 792-2665
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016144
BLUE SHIELD
KS
05
—
100245710A
—
KS
Enumeration date
08/09/2005
Last updated
04/01/2013
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