1447434121 NPI number — CLINTON BACK AND NECK CARE CENTER, PC

Table of content: (NPI 1447434121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447434121 NPI number — CLINTON BACK AND NECK CARE CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINTON BACK AND NECK CARE CENTER, PC
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:
PARKVIEW BACK AND NECK CARE CENTER
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:
1447434121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 N BLUFF BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52732-7119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-242-5375
Provider Business Mailing Address Fax Number:
563-242-5264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 PARKVIEW PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDRIDGE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-285-8230
Provider Business Practice Location Address Fax Number:
563-285-5122
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEROUX-TROXELL
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
563-242-5375

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  A05629 , 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)





Copyright © 2007-2024 www.npivalidator.com