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General NPI Number Information
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NPI Number | 1659555464
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Entity Type | Organization
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Legal Business Name | KEVIN C DODSON
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 1620 9TH ST
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City | EAST MOLINE
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State | IL
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Zip | 61244-2120
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Country | US
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Telephone | 309-755-3809
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Fax | 308-755-3860
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Provider Business Mailing Address
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Address Line | 1620 9TH ST P O BOX 664
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City | EAST MOLINE
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State | IL
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Zip | 61244-2120
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Country | US
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Telephone | 309-755-3809
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Fax | 308-755-3860
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN C DODSON
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Credential | DPM
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Telephone | 309-755-3809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 016004304
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License Number State | IL
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