MEDICARE: DODGE CITY HEALTHCARE GROUP LP

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	208600000X	Surgery Physician	0432750	KS

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	:	1548408602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DODGE CITY HEALTHCARE GROUP LP

Provider Business Mailing Address
First Line	:	112 W ROSS BLVD
Second Line	:	SUITE E
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7219
Country	:	US
Telephone Number	:	620-227-5334
Fax Number	:	620-227-5212

Provider Business Practice Location Address
First Line	:	112 W ROSS BLVD
Second Line	:	SUITE E
City	:	DODGE CITY
State	:	KS
Zip	:	67801-7219
Country	:	US
Telephone Number	:	620-227-5334
Fax Number	:	620-227-5212

Authorized Official
Title or Position	:	DIVISION PRESIDENT
Name	:	ROBERT KLEIN
Credential	:
Telephone Number	:	615-372-8500

Provider Enumeration Date	:	01/28/2009
Last Update Date	:	01/28/2009

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