1437628468 NPI number — IOWA TOTAL CARE, 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 1437628468 NPI number — IOWA TOTAL CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA TOTAL CARE, 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:
1437628468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7700 FORSYTH BLVD STE 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-1849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 JORDAN CREEK PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MONIES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
58026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-725-4477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PRIEST
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, MEDICAID SOLUTIONS
Authorized Official Telephone Number:
314-302-2859

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 302R0000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com