MEDICARE: MEDICAL HEIGHTS MEDICAL CENTER, PA

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124023064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL HEIGHTS MEDICAL CENTER, PA

Provider Business Mailing Address
First Line	:	100 W ROSS BLVD
Second Line	:	STE 2A
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7217
Country	:	US
Telephone Number	:	620-227-3141
Fax Number	:	620-227-8095

Provider Business Practice Location Address
First Line	:	100 W ROSS BLVD
Second Line	:	STE 2A
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7217
Country	:	US
Telephone Number	:	620-227-3141
Fax Number	:	620-227-8095

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CHRIS SANDOVAL
Credential	:
Telephone Number	:	620-227-3141

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/30/2008

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