1992013577 NPI number — ABBE CENTER FOR CMH @ G&G LIVING CENTERS

Table of content: DR. WILLIAM ANTHONY LAFFERTY DPM (NPI 1528139466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992013577 NPI number — ABBE CENTER FOR CMH @ G&G LIVING CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABBE CENTER FOR CMH @ G&G LIVING CENTERS
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:
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:
1992013577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 KOSCIUSKO ST
Provider Second Line Business Mailing Address:
PO BOX 967
Provider Business Mailing Address City Name:
GUTTENBERG
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52052-9463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-252-3811
Provider Business Mailing Address Fax Number:
563-927-6703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 11TH ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52405-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-398-3562
Provider Business Practice Location Address Fax Number:
319-398-3501
Provider Enumeration Date:
09/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KAESTNER
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
319-398-3562

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0074575 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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