Provider Demographics
NPI:1588825046
Name:DODGE CITY FAMILY PLANNING CLINIC
Entity Type:Organization
Organization Name:DODGE CITY FAMILY PLANNING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:620-225-1933
Mailing Address - Street 1:811 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-4412
Mailing Address - Country:US
Mailing Address - Phone:620-225-1933
Mailing Address - Fax:620-225-1933
Practice Address - Street 1:811 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-4412
Practice Address - Country:US
Practice Address - Phone:620-225-1933
Practice Address - Fax:620-225-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1100285261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097890AMedicaid
KS160220OtherBLUE CROSS/BLUE SHIELD