1952409716 NPI number — MARTIN G MEINDL DO

Table of content: MARTIN G MEINDL DO (NPI 1952409716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952409716 NPI number — MARTIN G MEINDL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEINDL
Provider First Name:
MARTIN
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1952409716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 S ILLINOIS AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
MASON CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50401-5489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-494-3041
Provider Business Mailing Address Fax Number:
641-494-3059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 N EISENHOWER
Provider Second Line Business Practice Location Address:
SUITE PEDS
Provider Business Practice Location Address City Name:
MASON CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50401-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-422-5437
Provider Business Practice Location Address Fax Number:
641-422-5800
Provider Enumeration Date:
09/20/2006

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: 2080A0000X , with the licence number:  01463 , 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: 1033704 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12256 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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