1184692188 NPI number — I CARE OF MUSCATINE, INC

Table of content: (NPI 1184692188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184692188 NPI number — I CARE OF MUSCATINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I CARE OF MUSCATINE, INC
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:
VISION CENTER PC
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:
1184692188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 N 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAPELLO
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52653-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-523-2020
Provider Business Mailing Address Fax Number:
319-523-5230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 N 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPELLO
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52653-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-523-2020
Provider Business Practice Location Address Fax Number:
319-523-5230
Provider Enumeration Date:
03/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
563-263-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , 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: 0221697 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".