Provider Demographics
NPI:1265487359
Name:C&S MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:C&S MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-408-9700
Mailing Address - Street 1:2200 SUMMERLON CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2905
Mailing Address - Country:US
Mailing Address - Phone:620-408-9700
Mailing Address - Fax:620-408-9701
Practice Address - Street 1:2200 SUMMERLON CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2905
Practice Address - Country:US
Practice Address - Phone:620-408-9700
Practice Address - Fax:620-408-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100451610AMedicaid
KS100451610AMedicaid