1710930086 NPI number — DUBUQUE INTERNAL MEDICINE PC

Table of content: (NPI 1710930086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710930086 NPI number — DUBUQUE INTERNAL MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBUQUE INTERNAL MEDICINE 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:
TRI-STATE DIALYSIS MANCHESTER
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:
1710930086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 DELHI ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
DUBUQUE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52001-6320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-557-9111
Provider Business Mailing Address Fax Number:
563-589-4046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 S 11TH ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52057-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-927-2532
Provider Business Practice Location Address Fax Number:
563-927-5579
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEINES
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
563-557-9111

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , 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)





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