Provider Demographics
NPI:1184739443
Name:HEART OF KANSAS FAMILY HEALTH CARE, INC.
Entity type:Organization
Organization Name:HEART OF KANSAS FAMILY HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QI COORD.
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-792-5700
Mailing Address - Street 1:1905 19TH ST.
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530
Mailing Address - Country:US
Mailing Address - Phone:620-792-5700
Mailing Address - Fax:620-792-5742
Practice Address - Street 1:1905 19TH ST.
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530
Practice Address - Country:US
Practice Address - Phone:620-792-5700
Practice Address - Fax:620-792-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003932810007Medicaid
KS461035OtherCHILDRENS MERCY
KS160510OtherBLUE SHIELD
KSDC6555OtherRAILROAD MEDICARE
KS100423810AMedicaid
KSDC6555OtherRAILROAD MEDICARE