1023076783 NPI number — STEVEN SEAN CASSABAUM MSPT

Table of content: (NPI 1700275112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023076783 NPI number — STEVEN SEAN CASSABAUM MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASSABAUM
Provider First Name:
STEVEN
Provider Middle Name:
SEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT
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:
1023076783
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 461
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEVADA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50201-0461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-382-3366
Provider Business Mailing Address Fax Number:
515-382-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEVADA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-382-7008
Provider Business Practice Location Address Fax Number:
515-382-7171
Provider Enumeration Date:
05/03/2006

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: 225100000X , with the licence number:  02179 , 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: 36591 . This is a "BLUE CROSS IND" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 56588 . This is a "BLUE CROSS ACT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 46601 . This is a "BLUE CROSS GRP" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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