1447220538 NPI number — RONALD WILLIAM CHARLES M.D.

Table of content: RONALD WILLIAM CHARLES M.D. (NPI 1447220538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447220538 NPI number — RONALD WILLIAM CHARLES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHARLES
Provider First Name:
RONALD
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1447220538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 W TOWNLINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50801-1054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-782-7091
Provider Business Mailing Address Fax Number:
641-782-3830

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1610 W TOWNLINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50801-1066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-782-3887
Provider Business Practice Location Address Fax Number:
641-782-3504
Provider Enumeration Date:
01/23/2006

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: 207X00000X , with the licence number:  27934 , 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: 0600460 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36174 . This is a "WMC-BCBS DME" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: DA 1838 . This is a "WMC FPC-MEDICARE RR" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 60046 . This is a "WMC BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 163495 . This is a "WMC FPC MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 33444 . This is a "WMC FPC-BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0293522 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0002105 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0424507 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0635011 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66046 . This is a "WMC BCBS SNF" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0283465 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03187 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0655001 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29352 . This is a "WMC BCBS ER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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