1407477839 NPI number — COMMUNITY HEALTH PARTNERS, LLC

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 1407477839 NPI number — COMMUNITY HEALTH PARTNERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH PARTNERS, LLC
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:
6
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:
1407477839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6601 WESTOWN PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-7733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-512-9225
Provider Business Mailing Address Fax Number:
515-512-9186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 SW VINTAGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANKENY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50023-7165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-512-9225
Provider Business Practice Location Address Fax Number:
515-512-9186
Provider Enumeration Date:
04/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ALLARD
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
515-512-9225

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IA24742 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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