Provider Demographics
NPI:1619002680
Name:COUNTY OF DODGE
Entity Type:Organization
Organization Name:COUNTY OF DODGE
Other - Org Name:DODGE COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PHN
Authorized Official - Phone:507-635-6150
Mailing Address - Street 1:P.O. BOX 129
Mailing Address - Street 2:42 E MAIN ST.
Mailing Address - City:DODGE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55927
Mailing Address - Country:US
Mailing Address - Phone:507-635-6150
Mailing Address - Fax:507-633-9601
Practice Address - Street 1:42 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DODGE CENTER
Practice Address - State:MN
Practice Address - Zip Code:55927
Practice Address - Country:US
Practice Address - Phone:507-635-6150
Practice Address - Fax:507-633-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8026557261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN458353100Medicaid
MN120575Medicare UPIN
MN06G58DOMedicare UPIN
MN8278DOMedicare UPIN
MN458353100Medicaid