| Organization Name: | DODGE CITY MEDICAL CLINIC, INC. |
| NPI Number: | 1407976624 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD ANTHONY BUCCO (PRESIDENT) |
| Mailing Address: | 561 Al Highway 69 S Suite B Hanceville |
| State: | AL US |
| Postal Code: | 350773403 |
| Phone Number: | 2562872345 |
| Fax Number: | |
| NPI Enumeration Date: | 03/30/2007 |
| NPI Last Update Date: | 12/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | MD27216 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |