1215034889 NPI number — ORAL SURGERY ASSOC OF IOWA CITY PC

Table of content: LINDA D. BOLING CRNA (NPI 1407815814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215034889 NPI number — ORAL SURGERY ASSOC OF IOWA CITY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL SURGERY ASSOC OF IOWA CITY PC
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:
1215034889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2814 NORTHGATE DR
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
IOWA CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52245-9568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-338-5484
Provider Business Mailing Address Fax Number:
319-338-9413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2814 NORTHGATE DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-338-5484
Provider Business Practice Location Address Fax Number:
319-338-9413
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARTWIG
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
319-338-5484

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , 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)





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