Provider Demographics
NPI:1508932476
Name:DODGE CITY HEALTHCARE GROUP LLC
Entity Type:Organization
Organization Name:DODGE CITY HEALTHCARE GROUP LLC
Other - Org Name:WESTERN PLAINS MEDICAL CENTER/WESTERN PLAINS MEDICAL COMPLEX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7220
Mailing Address - Street 1:3001 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2270
Mailing Address - Country:US
Mailing Address - Phone:620-225-8406
Mailing Address - Fax:620-225-8403
Practice Address - Street 1:3001 AVENUE A
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-225-8406
Practice Address - Fax:620-225-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSH-029-002282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
110037Medicare Oscar/Certification