1164409215 NPI number — DR. LEE A KAMSTRA M.D.

Table of content: DR. LEE A KAMSTRA M.D. (NPI 1164409215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164409215 NPI number — DR. LEE A KAMSTRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMSTRA
Provider First Name:
LEE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1164409215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 LINCOLN CIR SE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51041-1862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-737-2000
Provider Business Mailing Address Fax Number:
712-737-2115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 LINCOLN CIR SE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51041-1862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-737-2000
Provider Business Practice Location Address Fax Number:
712-737-2115
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  30024 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9099788 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: F64952 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0117562 . This is a "MEDICA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 703361023567 . This is a "PREFERRED ONE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0117562 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 4976 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 20948 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0634626 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46873 . This is a "BC/BS ER LOCATION" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 54147 . This is a "WELLMARK BCBS CLINIC LOCA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 54147 . This is a "FIRST ADMINISTRATORS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 426038405 . This is a "CIGNA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 426038405 . This is a "EQUITABLE LIFE & CASUALTY" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42603840551041 . This is a "WPS TRICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 6099788 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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