1184276958 NPI number — UNITY HEALTHCARE

Table of content: ROBIN MACCOLL FENNIMORE MD (NPI 1245377522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184276958 NPI number — UNITY HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY HEALTHCARE
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:
UNITYPOINT CLINIC - FAMILY MEDICINE - WILTON
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:
1184276958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 MULBERRY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSCATINE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52761-3433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-264-9100
Provider Business Mailing Address Fax Number:
563-264-9195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 OVESEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52778-9612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-732-2121
Provider Business Practice Location Address Fax Number:
563-732-4232
Provider Enumeration Date:
07/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ERICKSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
563-264-9100

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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