1225027238 NPI number — MR. RICHARD L JOENS L.I.S.W.

Table of content: MR. RICHARD L JOENS L.I.S.W. (NPI 1225027238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225027238 NPI number — MR. RICHARD L JOENS L.I.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOENS
Provider First Name:
RICHARD
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.I.S.W.
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:
1225027238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 INGERSOLL AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50312-3534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-279-6200
Provider Business Mailing Address Fax Number:
515-279-4528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 INGERSOLL AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50312-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-279-6200
Provider Business Practice Location Address Fax Number:
515-279-4528
Provider Enumeration Date:
10/21/2005

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: 1041C0700X , with the licence number:  01012 , 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: 0249649 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42628 . This is a "BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 002440 . This is a "VALUE OPTIONS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 235144 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0103 . This is a "DEERE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 42628 . This is a "FIRST ADMINISTRATORS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 9P5081 . This is a "EMPIRE BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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