1215904750 NPI number — ASSOCIATED ANESTHESIOLOGISTS, P.C.

Table of content: (NPI 1215904750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215904750 NPI number — ASSOCIATED ANESTHESIOLOGISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATED ANESTHESIOLOGISTS, P.C.
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:
1215904750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 WESTOWN PKWY STE 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-6720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-401-1950
Provider Business Mailing Address Fax Number:
515-401-1955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 PLEASANT 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:
50309-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-401-1950
Provider Business Practice Location Address Fax Number:
515-401-1955
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRAIN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
515-401-1950

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0041830 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06000 . This is a "BREAST & CERVICAL CARE GR" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 04183 . This is a "BLUE SHIELD GROUP #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 139380600 . This is a "US DEPT OF LABOR GROUP #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CT1420 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 102316 . This is a "HEALTH ALLIANCE GROUP #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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