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St Rose Health Center INC

General Practice in Great Bend, KS. Organization (NPI-2).

NPI number1003211269
StatusActive
Last updated in NPPESOct 9, 2018

Details

NPI
1003211269
Entity type
Organization (NPI-2)
Legal business name
St Rose Health Center INC
Organization subpart
No
Enumeration date
Oct 30, 2014
Last updated
Oct 9, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General Practice––Yes
207R00000X Internal Medicine––
225100000X Physical Therapist––
207Q00000X Family Medicine––

Practice location

3515 Broadway Ave
Great Bend, KS 67530-3633

Phone 620-792-2511

Mailing address

3515 Broadway Ave
Great Bend, KS 67530-3633

Phone 620-792-2511

Authorized official

Edward Herrman
President
7856235523

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