1235228826 NPI number — HEAVY MEDICINE INCORPORATED P C

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 1235228826 NPI number — HEAVY MEDICINE INCORPORATED P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEAVY MEDICINE INCORPORATED P C
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:
1235228826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 DES MOINES STREET
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50309-5547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-262-8707
Provider Business Mailing Address Fax Number:
515-265-5207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 DES MOINES ST
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50309-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-262-8707
Provider Business Practice Location Address Fax Number:
515-265-5207
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHRISTIAN
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
EVA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
515-262-8707

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19808 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0198085 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com