Healthcare Provider Details

I. General information

NPI: 1962660787
Provider Name (Legal Business Name): DODGE CITY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 SUMMERLON CIR
DODGE CITY KS
67801-2985
US

IV. Provider business mailing address

103 POWELL CT SUITE 200
BRENTWOOD TN
37027-5079
US

V. Phone/Fax

Practice location:
  • Phone: 620-408-9454
  • Fax: 620-408-9552
Mailing address:
  • Phone: 615-372-8500
  • Fax: 615-372-8572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M. GRACEY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 615-372-8500