1558362590 NPI number — MR. RICHARD J SOCWELL MS MSED

Table of content: MR. RICHARD J SOCWELL MS MSED (NPI 1558362590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558362590 NPI number — MR. RICHARD J SOCWELL MS MSED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOCWELL
Provider First Name:
RICHARD
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS MSED
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:
1558362590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 1ST ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-396-1066
Provider Business Mailing Address Fax Number:
319-396-8779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 E AVE NW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-396-3110
Provider Business Practice Location Address Fax Number:
319-396-8779
Provider Enumeration Date:
08/01/2005

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: 103T00000X , with the licence number:  00529 , 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: 14963 . This is a "BCBS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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