| NPI | 1649911157 |
|---|---|
| Doing Business As | CODAC AT SPEEDWAY |
| Entity Type | Organization |
| Authorized Contact | PAUL AXINN Contracts And Credentialing Manager 520-202-1755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2022-04-06 |