1750809109 NPI number — ACCURA HEALTHCARE OF BANCROFT LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750809109 NPI number — ACCURA HEALTHCARE OF BANCROFT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCURA HEALTHCARE OF BANCROFT LLC
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:
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:
1750809109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1603 22ND ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-963-1125
Provider Business Mailing Address Fax Number:
515-963-1081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 E RAMSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANCROFT
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50517-8137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-885-2463
Provider Business Practice Location Address Fax Number:
515-885-2759
Provider Enumeration Date:
09/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LENEAVE
Authorized Official First Name:
TED
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
515-963-1125

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com