1275881971 NPI number — DODSON PAIN CONSULTANTS PA CORP

Table of content: (NPI 1275881971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275881971 NPI number — DODSON PAIN CONSULTANTS PA CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DODSON PAIN CONSULTANTS PA CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DPC MEDICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275881971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 NATHAN LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55441-6306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-588-7099
Provider Business Mailing Address Fax Number:
763-522-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 NATHAN LN N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55441-6306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-588-7099
Provider Business Practice Location Address Fax Number:
763-522-2222
Provider Enumeration Date:
08/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DODSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
763-588-7099

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X , with the licence number: 52435 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)