1740272822 NPI number — JAN M FOOTE ARNP

Table of content: JAN M FOOTE ARNP (NPI 1740272822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740272822 NPI number — JAN M FOOTE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOOTE
Provider First Name:
JAN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
JAN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740272822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 PLEASANT STREET
Provider Second Line Business Mailing Address:
BLANK ADMINISTRATION
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-241-5926
Provider Business Mailing Address Fax Number:
515-241-5127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 PLEASANT STREET SUITE 300
Provider Second Line Business Practice Location Address:
BLANK CHILDREN'S PEDIATRIC CLINIC - ENDOCRINOLOGY
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-241-6500
Provider Business Practice Location Address Fax Number:
515-241-8911
Provider Enumeration Date:
08/16/2005

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: 363LP0200X , with the licence number:  C063378 , 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: 175150054 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1740272822 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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