1225147333 NPI number — RUBY CUREG MD

Table of content: RUBY CUREG MD (NPI 1225147333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225147333 NPI number — RUBY CUREG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUREG
Provider First Name:
RUBY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1225147333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1475
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50306-1475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-643-4973
Provider Business Mailing Address Fax Number:
515-643-2784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 NW 114TH ST
Provider Second Line Business Practice Location Address:
SUITE 345
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-7007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-222-7337
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2006

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: 208000000X , with the licence number:  19256 , 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: 1084962 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32016 . This is a "WELLMARK BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 2084962 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".