1770526733 NPI number — MONICA FORBES PA-C

Table of content: MONICA FORBES PA-C (NPI 1770526733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770526733 NPI number — MONICA FORBES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORBES
Provider First Name:
MONICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1770526733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEAR LAKE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50428-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-357-1800
Provider Business Mailing Address Fax Number:
641-357-1803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 S 17TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEAR LAKE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50428-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-357-1800
Provider Business Practice Location Address Fax Number:
641-357-1803
Provider Enumeration Date:
06/14/2006

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: 363AM0700X , with the licence number:  000918 , 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: 0424507 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0600460 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0635011 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0655001 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29352 . This is a "BCBS ER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0283465 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60046 . This is a "BCBS REG" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 33444 . This is a "FPC BCBS NRH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 36174 . This is a "BCBS DME" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0293522 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66046 . This is a "BCBS SNF" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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