Provider Demographics
NPI:1902125321
Name:GREAT PLAINS OF REPUBLIC CO, INC.
Entity Type:Organization
Organization Name:GREAT PLAINS OF REPUBLIC CO, INC.
Other - Org Name:REPUBIC COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOTTGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-527-6050
Mailing Address - Street 1:2420 G ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66935-2400
Mailing Address - Country:US
Mailing Address - Phone:785-527-2254
Mailing Address - Fax:785-527-2800
Practice Address - Street 1:2420 G ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2400
Practice Address - Country:US
Practice Address - Phone:785-527-2254
Practice Address - Fax:785-527-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175518Medicare Oscar/Certification