Active NPI
Kevin C Dodson
- Durable Medical Equipment & Medical Supplies
- East Moline, IL
National Provider Identifier
1659555464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 016004304
- Legal business name
- KEVIN C DODSON
- Practice address
- 1620 9TH St
East Moline, IL 61244-2120 - Phone
- (309) 755-3809
- Fax
- (308) 755-3860
- NPI assigned
- Dec 28, 2007
- Organization subpart
- Yes
- Parent organization
- KEVIN C DODSON
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kevin C Dodson, DPM
- Title
- Owner
- Phone
- (309) 755-3809
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 016004304 | IL | Primary |
Addresses
Primary practice location
1620 9TH St
East Moline, IL 61244-2120
Mailing address
1620 9TH St
P O Box 664
East Moline, IL 61244-2120
Phone (309) 755-3809
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0060201286 | Other | IL | BLUE CROSS BLUE SHIELD |
| IL0101 | Other | IL | UNITED HEALTHCARE |
| 0436154 | Other | IA | IME |
| P00204462 | Other | IA | MEDICARE RAILROAD |
| 480007485 | Other | IL | MEDICARE RAILROAD |
| IA0102 | Other | IA | UNITED HEALTH CARE |
| 020110 | Other | IL | HEALTH ALLIANCE |
| 326507258 | Other | IL | TRICARE |
| 36473 | Other | IA | WELLMARK BLUE CROSS/BLUE SHIELD |
| I12453 | Other | IA | MEDICARE |
National Provider Directory
National Provider Directory- Tax ID family
- Kevin C Dodson DPM
- Part of
- Kevin C Dodson DPM
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Prosthetic/Orthotic Supplier
- East Moline, IL
- NPI 1699056044
Locations
1620 9th St
East Moline, IL 61244
Phone (309) 755-3089
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Foot & Ankle Surgery Podiatrist
- East Moline, IL
- NPI 1629076559
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1198800000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1316131200000",
"number": "1659555464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1620 9TH ST",
"address_2": "P O BOX 664",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612442120",
"telephone_number": "309-755-3809",
"fax_number": "308-755-3860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 9TH ST",
"city": "EAST MOLINE",
"state": "IL",
"postal_code": "612442120",
"telephone_number": "309-755-3809",
"fax_number": "308-755-3860"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KEVIN C DODSON",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "KEVIN C DODSON",
"enumeration_date": "2007-12-28",
"last_updated": "2011-09-16",
"status": "A",
"authorized_official_last_name": "DODSON",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "309-755-3809",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "IL",
"license": "016004304",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0060201286",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "IL0101",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IME",
"identifier": "0436154",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00204462",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "480007485",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "IA0102",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "020110",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "326507258",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BLUE CROSS/BLUE SHIELD",
"identifier": "36473",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "I12453",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Moline, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.