1841284031 NPI number — DR. JILL LYNELLE MEADOWS MD

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 1841284031 NPI number — DR. JILL LYNELLE MEADOWS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADOWS
Provider First Name:
JILL
Provider Middle Name:
LYNELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VIBHAKAR
Provider Other First Name:
JILL
Provider Other Middle Name:
LYNELLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841284031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 5TH AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-1303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-811-7526
Provider Business Mailing Address Fax Number:
515-280-9525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 ORCHARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-811-7526
Provider Business Practice Location Address Fax Number:
515-280-7525
Provider Enumeration Date:
09/02/2005

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: 207V00000X , with the licence number:  25740 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 33019 , 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: 0195263 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03407 . This is a "WELLMARK BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 057570 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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