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 |