1104969781 NPI number — WCDC, INC.

Table of content: (NPI 1104969781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104969781 NPI number — WCDC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WCDC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104969781
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 W 5TH ST
Provider Second Line Business Mailing Address:
P.O. BOX 61
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52353-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-653-7248
Provider Business Mailing Address Fax Number:
319-653-7249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52353-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-653-7248
Provider Business Practice Location Address Fax Number:
319-653-7249
Provider Enumeration Date:
02/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
VICE PRESIDENT OF BUSINESS PRACTICE
Authorized Official Telephone Number:
319-653-7248

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0234013 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2234013 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1234013 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0103325 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".