| NPI | 1972099836 |
|---|---|
| Doing Business As | DODGE OUTPATIENT SERVICE CENTER |
| Entity Type | Organization |
| Authorized Contact | JOHN HOGEBOOM President/CEO 480-831-7566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251B00000X Case Management (Licence: AZ OTC9000) |
| 251J00000X Nursing Care (Licence: AZ OTC9000) | |
| 261Q00000X Clinic/Center | |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: AZ OTC9000) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: AZ OTC9000) | |
| 291U00000X Clinical Medical Laboratory (Licence: AZ OTC9000) | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: AZ OTC9000) | |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2023-02-14 |