Healthcare Provider Details

I. General information

NPI: 1679030787
Provider Name (Legal Business Name): GLOBAL BONE AND JOINT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SUMMERLON CIR STE B
DODGE CITY KS
67801-2905
US

IV. Provider business mailing address

2200 SUMMERLON CIR STE B
DODGE CITY KS
67801-2905
US

V. Phone/Fax

Practice location:
  • Phone: 620-371-5252
  • Fax: 620-371-5126
Mailing address:
  • Phone: 620-371-5252
  • Fax: 620-371-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KASHIF ASHFAQ
Title or Position: OWNER
Credential:
Phone: 620-371-5252