1720056492 NPI number — WOMENS HEALTH SERVICES OF EASTERN IOWA INC

Table of content: (NPI 1720056492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720056492 NPI number — WOMENS HEALTH SERVICES OF EASTERN IOWA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS HEALTH SERVICES OF EASTERN IOWA 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:
WOMEN'S HEALTH SERVICES
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:
1720056492
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2635 LINCOLN WAY
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52732-7203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-243-1413
Provider Business Mailing Address Fax Number:
563-242-9992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2635 LINCOLN WAY
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52732-7203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-243-1413
Provider Business Practice Location Address Fax Number:
563-242-9992
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
563-243-1413

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0154476 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0285106 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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