1275151003 NPI number — LINN COUNTY EMERGENCY MEDICINE PC

Table of content: (NPI 1275151003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275151003 NPI number — LINN COUNTY EMERGENCY MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINN COUNTY EMERGENCY MEDICINE 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:
1275151003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 RIDGLEA PL STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76116-5707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-451-4208
Provider Business Mailing Address Fax Number:
817-563-3699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1195 BOYSON RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIAWATHA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52233-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-832-3950
Provider Business Practice Location Address Fax Number:
319-832-3951
Provider Enumeration Date:
07/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PERAUD
Authorized Official First Name:
PETER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT / OWNER
Authorized Official Telephone Number:
319-398-6249

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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