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1513 W Wyatt Earp Blvd Dodge City KS 67801-3352 | |
(620) 682-8305 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1513 W Wyatt Earp Blvd, Dodge City, Kansas |
Authorized Official Name and Position | Grant Asay (CEO) |
Authorized Official Contact | 4054451210 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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701 Cedar Lake Blvd Ste 120 Oklahoma City OK 73114-7815 Ph: (405) 445-1210 | 1513 W Wyatt Earp Blvd Dodge City KS 67801-3352 Ph: (620) 682-8305 |
NPI Number | 1578133328 |
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Provider Enumeration Date | 06/24/2021 |
Last Update Date | 02/24/2023 |
Medicare PECOS PAC ID | 3375832157 |
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Medicare Enrollment ID | O20210728002960 |
Identifier | Type | State | Issuer |
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1578133328 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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