1245581560 NPI number — STROKE DETECTIONS PLUS, INC.

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 1245581560 NPI number — STROKE DETECTIONS PLUS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STROKE DETECTIONS PLUS, INC.
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:
1245581560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2407 SW 9TH STREET
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:
50315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-244-3080
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2407 SW 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-244-3080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCGLOTHLEN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-471-8402

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  39465 , 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: 16D1038950 . This is a "CLIA" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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