Provider Demographics
NPI:1124023064
Name:MEDICAL HEIGHTS MEDICAL CENTER, PA
Entity Type:Organization
Organization Name:MEDICAL HEIGHTS MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-227-3141
Mailing Address - Street 1:100 W ROSS BLVD
Mailing Address - Street 2:STE 2A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7217
Mailing Address - Country:US
Mailing Address - Phone:620-227-3141
Mailing Address - Fax:620-227-8095
Practice Address - Street 1:100 W ROSS BLVD
Practice Address - Street 2:STE 2A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-7217
Practice Address - Country:US
Practice Address - Phone:620-227-3141
Practice Address - Fax:620-227-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100216110AMedicaid
KS016766Medicare UPIN