Provider Demographics
NPI:1295936367
Name:CITY OF DODGE CENTER
Entity type:Organization
Organization Name:CITY OF DODGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:ALLEN-ORVILLE
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-633-2005
Mailing Address - Street 1:P.O. BOX 430
Mailing Address - Street 2:35 E MAIN STREET
Mailing Address - City:DODGE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55927
Mailing Address - Country:US
Mailing Address - Phone:507-374-2575
Mailing Address - Fax:
Practice Address - Street 1:130 E HIGHWAY STREET
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:507-374-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3416L0300X3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN372867600Medicaid
MNBLUE CROSS BLUE SHEIOtherINSURANCE
MN372867600Medicaid