1659376556 NPI number — SHARON KAY MCELHINNEY DO

Table of content: SHARON KAY MCELHINNEY DO (NPI 1659376556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659376556 NPI number — SHARON KAY MCELHINNEY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCELHINNEY
Provider First Name:
SHARON
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DYKSTRA
Provider Other First Name:
SHARON
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1659376556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 W KIMBERLY ROAD
Provider Second Line Business Mailing Address:
DAVENPORT HEALTHPLEX, PEDS
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-421-0010
Provider Business Mailing Address Fax Number:
563-421-0009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 W KIMBERLY ROAD
Provider Second Line Business Practice Location Address:
DAVENPORT HEALTHPLEX, PEDS
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-421-0010
Provider Business Practice Location Address Fax Number:
563-421-0009
Provider Enumeration Date:
06/16/2005

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: 208000000X , with the licence number:  02455 , 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: 5066423 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034796 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19909 . This is a "IOWA HEALTH SOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29771 . This is a "WELLMARK BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA0127 . This is a "JOHN DEERE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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