1285694059 NPI number — EILEEN M MIDDLETON PA

Table of content: EILEEN M MIDDLETON PA (NPI 1285694059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285694059 NPI number — EILEEN M MIDDLETON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIDDLETON
Provider First Name:
EILEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1285694059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3549 SOUTHERN HILLS DR
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
SIOUX CITY
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51106-4736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-274-6729
Provider Business Mailing Address Fax Number:
712-274-6744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51101-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-234-0220
Provider Business Practice Location Address Fax Number:
712-234-0225
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  001320 , 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: 37256 . This is a "WELLMARK" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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