MEDICARE: DOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	78-82	NM

General Provider Information

NPI Number	:	1336119403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOD

Provider Business Mailing Address
First Line	:	710 HERBGLEN CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7692
Country	:	US
Telephone Number	:	710-540-9745
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 COCHRANE CIR
Second Line	:	FT.CARSON
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80913-7692
Country	:	US
Telephone Number	:	710-524-4289
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL OFFICER
Name	:	DR. YASHODA BT SAGAR
Credential	:	M.D
Telephone Number	:	710-524-4289

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/22/2020

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Directions to “DOD ” Practice Location

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