MEDICARE: SURGERY CENTER OF DODGE CITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	S029001	KS

General Provider Information

NPI Number	:	1013915685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF DODGE CITY, LLC

Provider Business Mailing Address
First Line	:	2203 SUMMERLON CIR
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2985
Country	:	US
Telephone Number	:	620-408-9454
Fax Number	:	620-408-9552

Provider Business Practice Location Address
First Line	:	2203 SUMMERLON CIR
Second Line	:
City	:	DODGE CITY
State	:	KS
Zip	:	67801-2985
Country	:	US
Telephone Number	:	620-408-9454
Fax Number	:	620-408-9552

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DINA LANE
Credential	:	BSN
Telephone Number	:	620-408-9454

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/22/2020

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