1538321971 NPI number — DR. SARAH A BANCROFT DO

Table of content: DR. SARAH A BANCROFT DO (NPI 1538321971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538321971 NPI number — DR. SARAH A BANCROFT DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANCROFT
Provider First Name:
SARAH
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRISMANITS
Provider Other First Name:
SARAH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538321971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 DUFF AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50010-3014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-239-3410
Provider Business Mailing Address Fax Number:
515-817-1237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 1001
Provider Business Practice Location Address City Name:
AMES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-239-3410
Provider Business Practice Location Address Fax Number:
515-817-1237
Provider Enumeration Date:
06/26/2008

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: 207QS0010X , with the licence number:  04989 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 5101017596 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 201162230 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151020015 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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