Healthcare Provider Details

I. General information

NPI: 1437131265
Provider Name (Legal Business Name): DODGE CITY MEDICAL CENTER CHARTERED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CENTRAL AVE
DODGE CITY KS
67801-6411
US

IV. Provider business mailing address

PO BOX 1000
DODGE CITY KS
67801-1000
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-1371
  • Fax: 620-227-1208
Mailing address:
  • Phone: 620-227-1371
  • Fax: 620-227-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: NINA FROETSCHNER
Title or Position: ADM ASSISTANT
Credential:
Phone: 620-227-1206