Organization
GREAT PLAINS OF REPUBLIC CO., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID-PAUL CAVAZOS (ADMINISTRATOR)
(785) 527-6000
Entity
Organization
Contact information
Practice address
2420 G ST, BELLEVILLE, KS 66935-2400
(785) 527-2254
(785) 527-2800
Mailing address
2420 G ST, BELLEVILLE, KS 66935-2400
(785) 527-2254
(785) 527-2800
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207L00000X
Anesthesiology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012262
BLUE SHIELD OF KS
KS
05
—
100409140B
—
KS
01
—
111088
BLUE SHIELD OF KANSAS
KS
Enumeration date
07/26/2006
Last updated
05/14/2025
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