Provider Demographics
NPI:1437131265
Name:DODGE CITY MEDICAL CENTER CHARTERED
Entity Type:Organization
Organization Name:DODGE CITY MEDICAL CENTER CHARTERED
Other - Org Name:DODGE CITY MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADM ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROETSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-227-1206
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1000
Mailing Address - Country:US
Mailing Address - Phone:620-227-1371
Mailing Address - Fax:620-227-1208
Practice Address - Street 1:2020 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6411
Practice Address - Country:US
Practice Address - Phone:620-227-1371
Practice Address - Fax:620-227-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0587270001Medicare NSC