Provider Demographics
NPI:1275322604
Name:MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIZED SERVICES SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KODICEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-662-5475
Mailing Address - Street 1:1645 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3638
Mailing Address - Country:US
Mailing Address - Phone:602-291-4414
Mailing Address - Fax:602-372-0342
Practice Address - Street 1:1950 S COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6043
Practice Address - Country:US
Practice Address - Phone:602-291-4414
Practice Address - Fax:602-372-0342
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARICOPA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local