1629021118 NPI number — RONNIE HAWKINS FAMILY PRACTICE MEDICAL CLINIC PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629021118 NPI number — RONNIE HAWKINS FAMILY PRACTICE MEDICAL CLINIC PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONNIE HAWKINS FAMILY PRACTICE MEDICAL CLINIC PLC
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:
DR. HAWKINS OFFICE
Provider Other Organization Name Type Code:
3
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:
1629021118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 22ND ST
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-224-1001
Provider Business Mailing Address Fax Number:
515-224-1004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 22ND ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-224-1001
Provider Business Practice Location Address Fax Number:
515-224-1004
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARAZANJI
Authorized Official First Name:
MAJED
Authorized Official Middle Name:
WALEED
Authorized Official Title or Position:
OWNER/PRACTITIONER
Authorized Official Telephone Number:
515-440-6622

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  22705 , 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: 0281865 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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