Healthcare Provider Details

I. General information

NPI: 1538612429
Provider Name (Legal Business Name): ARIZONA OUTPATIENT SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3759 N COMMERCE DR
TUCSON AZ
85705-6911
US

IV. Provider business mailing address

3759 N COMMERCE DR
TUCSON AZ
85705-6911
US

V. Phone/Fax

Practice location:
  • Phone: 214-754-8700
  • Fax: 214-754-8700
Mailing address:
  • Phone: 214-754-8700
  • Fax: 214-754-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD GODBOLD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 209-872-0480