1841286176 NPI number — JEROME RICHARD GREENBERG OD

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 1841286176 NPI number — JEROME RICHARD GREENBERG OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENBERG
Provider First Name:
JEROME
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1841286176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1242 E 14TH ST
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:
50316-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-263-0295
Provider Business Mailing Address Fax Number:
515-263-0115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1242 E 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50316-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-263-0295
Provider Business Practice Location Address Fax Number:
515-263-0115
Provider Enumeration Date:
09/22/2005

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: 152W00000X , with the licence number:  1709 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 6938 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 421168561 . This is a "AUTO OWNERS, PRAIRIE STATES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "AMERICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81376 . This is a "COVENTRY ADVANTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "ADVANTRA FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "MED BEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "UNITED AMERICAN INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1709 . This is a "IOWA LICENSE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "BRIDGESTONE/FIRESTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "DEFINITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "BANKERS LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "CENTRAL RESERVE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "EBC (EMPLOYEE BENEFIT CONSULTANTS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "PIRELLI ARMSTRONG" identifier . This identifiers is of the category "OTHER".
  • Identifier: IA0101 . This is a "UNITED HEALTHCARE OF THE RIVER VALLEY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17996 . This is a "WELLMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17996 . This is a "FIRST ADMINISTRATORS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 17996 . This is a "MUTUAL OF OMAHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "MAILHANDLERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421168561 . This is a "AMERICAN REPUBLIC" identifier . This identifiers is of the category "OTHER".




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