Provider Demographics
NPI:1285019141
Name:HODGEMAN COUNTY MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:HODGEMAN COUNTY MEDICAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:620-357-6428
Mailing Address - Street 1:2200 SUMMERLON CIR
Mailing Address - Street 2:STE A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2900
Mailing Address - Country:US
Mailing Address - Phone:620-408-9700
Mailing Address - Fax:620-408-9701
Practice Address - Street 1:2200 SUMMERLON CIR
Practice Address - Street 2:STE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2900
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:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS422287261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care