MEDICARE: ARIZONA OUTPATIENT SERVICES PC

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	363L00000X	Nurse Practitioner
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1538612429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA OUTPATIENT SERVICES PC

Provider Business Mailing Address
First Line	:	3759 N COMMERCE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-6911
Country	:	US
Telephone Number	:	214-754-8700
Fax Number	:	214-754-8700

Provider Business Practice Location Address
First Line	:	3759 N COMMERCE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-6911
Country	:	US
Telephone Number	:	214-754-8700
Fax Number	:	214-754-8700

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD GODBOLD
Credential	:	M.D.
Telephone Number	:	209-872-0480

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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