1184729063 NPI number — THE COMMUNITY NURSING SERVICE

Table of content: ALEXIS MARY MCMAHON SPEECH PATHOLOGIST (NPI 1104331321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184729063 NPI number — THE COMMUNITY NURSING SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COMMUNITY NURSING SERVICE
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:
1184729063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1202
Provider Second Line Business Mailing Address:
11 NORTH 1ST AVENUE
Provider Business Mailing Address City Name:
MARSHALLTOWN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50158-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-752-4611
Provider Business Mailing Address Fax Number:
641-752-5404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 N 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALLTOWN
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50158-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-752-4611
Provider Business Practice Location Address Fax Number:
641-752-5404
Provider Enumeration Date:
09/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AVES
Authorized Official First Name:
DELAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY DIRECTOR
Authorized Official Telephone Number:
641-752-4611

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: 0670992 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 67099 . This is a "WELLMARK BC/BS OF IOWA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".