1699785048 NPI number — FOODS INC

Table of content: MATTHEW GREGORY GARRITY DO (NPI 1952154312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699785048 NPI number — FOODS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOODS 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:
Provider Other Organization Name Type Code:
6
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:
1699785048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 E 33RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50317-3835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-262-7942
Provider Business Mailing Address Fax Number:
515-264-8408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 E 33RD 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:
50317-3835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-262-7942
Provider Business Practice Location Address Fax Number:
515-264-8408
Provider Enumeration Date:
08/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORROW
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
515-255-8642

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  278 , 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: 0076455 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1603390 . This is a "NABP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: I20027 . This is a "MEDICARE FLU ROSTER" identifier . This identifiers is of the category "OTHER".